Evidence map›Paper›PMID 42192090›Full record

ReviewCardiovascular intervention and therapeutics2026

Optimal time for aspirin withdrawal after PCI in ACS: a pairwise and network meta-analysis with time to event data of randomized trials.

Abdalhakim Shubietah, Mohamed S Elgendy, Mohamed Saad Rakab, Elsayed Balbaa, Ahmed Emara, Belal Mohamed Hamed, Qasem Salah, Anas Odeh, Hamza A Abdul-Hafez, Ameer Awashra and 5 more

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In one paragraph

Review in Cardiovascular intervention and therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Abdalhakim ShubietahDepartment of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
Mohamed S ElgendyFaculty of Medicine, Tanta University, Tanta, Egypt.
Mohamed Saad RakabFaculty of Medicine, Mansoura University, Mansoura, Egypt.
Elsayed BalbaaFaculty of Medicine, Alexandria University, Alexandria, Egypt.
Ahmed EmaraFaculty of Medicine, Al-Azhar University, Cairo, Egypt.
Belal Mohamed HamedFaculty of Medicine, Al-Azhar University, Cairo, Egypt.
Qasem SalahDepartment of Medicine, An-Najah National University, Nablus, Palestine.
Anas OdehDepartment of Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA.
Hamza A Abdul-HafezDepartment of Medicine, An-Najah National University, Nablus, Palestine.
Ameer AwashraDepartment of Medicine, An-Najah National University, Nablus, Palestine. ameer.awashra7@gmail.com.ORCID http://orcid.org/0009-0002-5122-8200
Mohamed AbuelazmFaculty of Medicine, Tanta University, Tanta, Egypt.
Ariel KatzDepartment of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
Rocio Carla Barriga GuzmanDepartment of Cardiology, University of Nebraska Medical Center, Lincoln, NE, USA.
Mohammed MhannaDivision of Cardiovascular Medicine, University of Iowa, Iowa, IA, USA.
Mohammed RuziehDepartment of Cardiology, University of Florida, Gainesville, FL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

In patients with ACS undergoing PCI, de-escalation to P2Y12-inhibitor monotherapy reduces bleeding, but the optimal timing of aspirin withdrawal is uncertain. We conducted pairwise and network meta-analyses of randomized trials comparing P2Y12-inhibitor monotherapy after aspirin discontinuation versus dual antiplatelet therapy (DAPT) in ACS post-PCI. Random-effects models were used. The network meta-analysis (NMA) compared four strategies (12-month DAPT [central comparator]; aspirin stop < 1 month, 1-2 months, or 3 months) and ranked treatments using SUCRA. (PROSPERO ID: CRD420251151605). A total of 33,292 participants from 10 RCTs were included. In the pairwise meta-analysis, monotherapy reduced net adverse clinical events (NACE) (5.1% vs. 6.7%; RR: 0.75; 95% CI: 0.65-0.86) and bleeding, including clinically relevant bleeding (RR: 0.45; 95% CI: 0.39-0.53) and major bleeding (RR: 0.47; 95% CI: 0.37-0.60). In the NMA, aspirin discontinuation at 3 months showed a trend toward lower NACE versus 12-month DAPT (RR 0.66; 95% CI 0.42-1.04) and ranked most favorable for net and ischemic outcomes (NACE, MI, MACCE, and all-cause mortality), although estimates for individual ischemic endpoints were imprecise and not statistically different from 12-month DAPT. Aspirin discontinuation at < 1 month showed an unfavorable mortality ranking, with a concordant meta-regression signal suggesting higher mortality with earlier aspirin withdrawal. De-escalation to P2Y₁₂ inhibitor monotherapy after PCI in ACS reduced NACE, mainly by lowering bleeding. In network analyses, aspirin discontinuation at 3 months ranked most favorable for net and ischemic outcomes, whereas discontinuation at < 1 month showed an unfavorable mortality signal.

Indexed as

Acute Coronary SyndromeAspirinPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsDual Anti-Platelet TherapyHemorrhageHumansPurinergic P2Y Receptor AntagonistsRandomized Controlled Trials as TopicTime FactorsTreatment InterruptionAspirinPlatelet Aggregation InhibitorsPurinergic P2Y Receptor AntagonistsAcute coronary syndromeAspirinDe-escalationDual antiplatelet therapyMeta-analysis.P2Y12 inhibitor monotherapy

Identifiers

PMID42192090

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.