Low-dose aspirin for PCI

Patients with acute coronary artery syndrome and those undergoing percutaneous coronary intervention (PCI) should be maintained on low-dose aspirin therapy, a recent study demonstrates.

The effect of dosing is of significant interest given the requirement for dual antiplatelet therapy following PCI, the increased risk of bleeding associated with newer, more potent adenosine diphosphate antagonists, and the potential for drug-to-drug interactions, wrote Roxana Mehran, MD, of Mount Sinai School of Medicine in New York, NY, and colleagues.

The article, published in the December issue of JACC: Cardiovascular Interventions, found that patients who were discharged on and maintained on high-dose aspirin were more likely to have major bleeding than patients on low-dose aspirin. However, the authors reported no difference in ischemic end points between high- and low-dose aspirin used in combination with clopidogrel.

The researchers examined the impact of aspirin dose on late outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The authors assessed 3-year outcomes from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction).

The study assessed the end points for 2,851 patients with STEMI who underwent primary PCI and were discharged on high-dose aspirin (>200 mg daily) versus low-dose aspirin (≤200 mg daily). After propensity score-adjusted multivariable analysis, the authors found high-dose aspirin was an independent predictor for non-coronary artery bypass graft-related major bleeding (HR, 2.80; 95% CI: 1.31 to 5.99; P=.008). Further, the authors noted that the increase in major bleeding events occurred in the first 2 months after hospital discharge and continued to accrue in the high-dose group over the entire 3-year follow-up period.

“Absent a demonstrated benefit of high-dose aspirin in patients on dual antiplatelet therapy with clopidogrel following PCI, and given the concern of potential harm of high-dose aspirin used with more potent P2Y12 inhibitors, these data support the routine use of low-dose aspirin (<200 mg daily) at discharge following primary PCI in STEMI,” the authors concluded.