Requiem for Aspirin in Dual Antiplatelet Therapy?

Hi. This is Dr Michelle O'Donoghue, reporting for Medscape. I'm here at the Transcatheter Cardiovascular Therapeutics (TCT) conference in San Diego, and one topic that keeps coming up for discussion, with people on very different sides of the issue, is the optimal duration of dual antiplatelet therapy (DAPT). But the twist that I'd like to put on this topic today, and hear people's thoughts on, is whether we should be thinking about it differently. This isn't really a question of extending treatment with a P2Y12 inhibitor, but about whether we should be considering dropping aspirin from a DAPT regimen sooner.

I would argue that when we look at the weight of the evidence overall, several trials have compared longer durations of DAPT with a P2Y12 inhibitor compared with shorter durations. Particularly in acute coronary syndrome (ACS) patients, we tend to see that by prolonging DAPT we reduce the risk for ischemic and thrombotic events, but that it comes at the price of increased risk of bleeding. It is intriguing that the same is not exactly true when we drop aspirin from a DAPT regimen, although so far, evidence is fairly limited.

A few years ago we had the intriguing findings from