J Cardiovasc Interv.  2023 Jan;2(1):9-18. 10.54912/jci.2022.0019.

The Role of P2Y12 Inhibitor Monotherapy in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

• Choi KH
• Song YB

• KMID: 2561265
• DOI: http://doi.org/10.54912/jci.2022.0019

Abstract

Antiplatelet therapy is essential for reducing systemic and local thrombotic events during management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). With the remarkable improvements that have been made in both medical therapies and device technologies in the interventional cardiology field, antiplatelet treatment strategies are currently shifting toward reducing the risk of bleeding over time. Several key randomized controlled trials have been conducted to evaluate the efficacy and safety of P2Y12 inhibitor monotherapy (early discontinuation of aspirin) following a short duration of dual antiplatelet therapy (DAPT) after PCI, and consistently revealed a reduction in the risk of bleeding and no significant increase in ischemic events compared to a conventional DAPT strategy. Based on these results, discontinuing aspirin at the time of transition from DAPT to single antiplatelet therapy has become an attractive option in clinical practice and is endorsed by clinical practice guidelines. This review summarizes the current evidence for aspirin discontinuation with P2Y12 inhibitor monotherapy after DAPT in patients who underwent PCI, and discusses the current issues, future trials, and practical implications associated with this approach.

Keyword

Antiplatelet therapy; P2Y12 inhibitor monotherapy; Aspirin discontinuation; Coronary artery disease; Percutaneous coronary intervention