Benefits of Early Aspirin Discontinuation in Low-Risk Heart Attack Patients

Recent research suggests that for low-risk patients who experience a myocardial infarction (heart attack) and undergo early complete revascularization, stopping aspirin therapy after one month may be safe and beneficial. A large European trial involving nearly 2,000 participants demonstrated that switching from dual antiplatelet therapy (DAPT) to P2Y12 inhibitor monotherapy after one month did not increase the risk of adverse cardiovascular events such as death, heart attacks, or stroke. Instead, this approach significantly reduced bleeding complications, a common concern with prolonged aspirin use.

The study, presented at ESC Congress 2025 and published in the New England Journal of Medicine, involved patients who received modern drug-eluting stents and achieved complete revascularization within a week of their MI. These participants continued with DAPT—aspirin plus a P2Y12 inhibitor—for one month, after which they were randomized to either remain on DAPT or switch to P2Y12 inhibitor monotherapy for the following 11 months.

Findings showed comparable rates of major cardiovascular events between both groups, with the monotherapy group experiencing fewer significant bleedings. The overall composite outcome—covering death, MI, stent thrombosis, stroke, and major bleeding—was lower in patients who discontinued aspirin early. Lead investigator Professor Giuseppe Tarantini explained that in carefully selected low-risk patients, early de-escalation could balance protection from ischemic events while minimizing bleeding risks, thanks to advancements in stent technology and medical care.

These results challenge traditional guidelines, which recommend 12 months of DAPT after MI, suggesting that tailored, shorter-duration therapy may be appropriate for certain low-risk groups. The study highlights the importance of modern revascularization techniques and personalized therapy in optimizing patient outcomes.

Source: https://medicalxpress.com/news/2025-09-early-aspirin-discontinuation-linked-benefits.html