Aspirin-free antiplatelet regimens after PCI: insights from the GLOBAL LEADERS trial and beyond

Eur Heart J Cardiovasc Pharmacother. 2021 Apr 30;pvab035. doi: 10.1093/ehjcvp/pvab035. Online ahead of print.

Abstract

Historically, aspirin has been the primary treatment for the prevention of ischemic events in patients with coronary artery disease. For patients undergoing percutaneous coronary intervention (PCI) standard treatment has been 12-months of dual anti-platelet therapy (DAPT) with aspirin and clopidogrel, followed by aspirin monotherapy; however, DAPT is undeniably associated with an increased risk of bleeding. For over a decade novel P2Y12 inhibitors, which have increased specificity, potency and efficacy have been available, prompting studies which have tested whether these newer agents can be used in aspirin-free anti-platelet regimens to augment clinical benefits in patients post-PCI. Among these studies, the GLOBAL LEADERS trial is the largest by cohort size, and so far has provided a wealth of evidence in a variety of clinical settings and patient groups. This article summarizes the state-of-the-art evidence obtained from the GLOBAL LEADERS and other trials of aspirin-free strategies.

Keywords: Aspirin-free therapy; GLOBAL LEADERS; P2Y12 inhibitor; Percutaneous coronary intervention; Randomized clinical trials.