Selecting an Aspirin-Free Strategy for Patients with High Bleeding Risk Undergoing PCI: Does ACS Indication Matter?

When choosing an antiplatelet strategy for our patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent placement who have high bleeding risk, when should we consider dropping aspirin from the regimen? In a recent randomized, controlled trial in this population, compared with prasugrel plus aspirin, prasugrel monotherapy did not reduce 30-day incidence of major bleeding or significantly increase a composite of ischemic endpoints (cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke). To assess whether outcomes might differ for patients presenting with acute coronary syndrome (ACS) versus other indications for PCI, the investigators performed a subgroup analysis in 3250 patien…