Skip the aspirin? New study suggests prasugrel alone a safe option for CAD patients after PCI

Clinicians may be able to treat coronary artery disease (CAD) patients who undergo percutaneous coronary intervention (PCI) with a P2Y12 inhibitor alone, skipping aspirin altogether, according to a new analysis published in JACC: Cardiovascular Interventions.  

CAD patients typically receive dual-antiplatelet therapy that includes aspirin and a P2Y12 inhibitor after PCI, but the study’s authors tested the safety of just prasugrel, an oral P2Y12 inhibitor, on 201 patients. Patients were enrolled from February 2018 to May 2019, and the mean age was 59.5 years old.

The study’s primary ischemic endpoint, the composite of cardiac death, spontaneous target vessel myocardial infarction or definite stent thrombosis, occurred in a single patient. The study’s primary bleeding endpoint, Bleeding Academic Research Consortium types three and five bleeding for up to three months, also occurred in just a single patient.

One key detail, the authors noted, is that no stent thrombosis events were reported.

“This finding is not surprising, but to the best of our knowledge, this is the first prospective experience of withholding aspirin the day after index PCI while administrating monotherapy with a P2Y12 inhibitor,” wrote lead author Norihiro Kogame, MD, Amsterdam University Medical Center in the Netherlands, and colleagues.

Kogame et al. did note that their study had certain limitations. It was a nonrandomized study, for instance, meaning no specific conclusions could be reached about the effectiveness of prasugrel monotherapy when compared to conventional dual-antiplatelet therapy.

Overall, however, the findings could be a sign of big changes to come for PCI care.

“Aspirin-free prasugrel monotherapy was feasible and safe following successful drug-eluting stent implantation in a population of selected patients with stable CAD with low anatomic complexity,” the authors concluded. “Our findings may help underpin larger randomized controlled studies to evaluate the aspirin-free strategy compared with traditional dual-antiplatelet therapy following PCI.”

The full study is available here.