Do you withhold Acetylsalicylic acid (aspirin) before Percutaneous Coronary Intervention (PCI)?

From the Guidelines

Aspirin Therapy in Percutaneous Coronary Intervention (PCI)

Aspirin therapy should not be withheld before Percutaneous Coronary Intervention (PCI), as it reduces the risk of peri-procedural myocardial infarction [ 1, 1, 1, 1, 1 ].

• A dose of 81-325 mg of aspirin should be administered at least 2 hours before the procedure [ 1, 1, 1, 1, 1 ].
• Ideally, patients should be on a maintenance dose of 81-100 mg daily for at least 7 days prior to PCI [ 1, 1, 1, 1, 1 ].
• Holding aspirin is not recommended, unless there is a high risk of bleeding, in which case the decision to withhold aspirin should be made on a case-by-case basis [ 1, 1, 1, 1, 1 ].
• After PCI, aspirin should be continued indefinitely at a dose of 81-325 mg daily [ 1, 1 ].
• The use of a P2Y12 receptor inhibitor should also be considered, with options including clopidogrel, prasugrel, and ticagrelor [ 1, 1 ].

From the Research

Aspirin Use in Percutaneous Coronary Intervention (PCI)

• The use of aspirin in patients undergoing PCI is a common practice, but its necessity is being reevaluated in certain cases 2.
• Studies have shown that aspirin-free strategies can be effective in reducing bleeding events without increasing ischemic risk 2, 3.
• Dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 receptor inhibitor is the standard of care for patients undergoing PCI, but individualization of DAPT duration is necessary, particularly in high bleeding risk patients 2, 3.

Benefits and Risks of Aspirin in PCI

• Aspirin has been shown to reduce the risk of cardiovascular death, myocardial infarction, or urgent target-vessel revascularisation in patients undergoing PCI 4.
• However, aspirin also increases the risk of bleeding, and its use should be carefully considered in patients with high bleeding risk 5, 3.
• Recent studies have suggested that early aspirin discontinuation (at 3 months or even 1 month) after PCI may reduce bleeding risk without increasing ischemic events 3.

Special Considerations

• In patients with prior PCI undergoing noncardiac surgery, aspirin may be beneficial in reducing the risk of myocardial infarction, but its effect on bleeding is uncertain 5.
• Aspirin hypersensitivity poses a significant clinical dilemma, and aspirin desensitization may be a potential option, but it may not always be practical 6.
• The choice of P2Y12 inhibitor and the duration of DAPT should be tailored to individual patient ischemic and bleeding risks 3.