{"id":"2c4e664fdf86","type":"article","url":"https://hartvaat.nl/2024/02/20/stopdapt-3-aspirinevrij-versus-standaard-dapt-na-coronaire-stenting/","title":"STOPDAPT-3: aspirinevrij versus standaard DAPT na coronaire stenting","title_en":"An Aspirin-Free Versus Dual Antiplatelet Strategy for Coronary Stenting: STOPDAPT-3 Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.066720","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.066720","authors":["Masahiro Natsuaki","Hirotoshi Watanabe","Takeshi Morimoto","Ko Yamamoto","Yuki Obayashi","Ryusuke Nishikawa","Kenji Ando","Takenori Domei","Satoru Suwa","Manabu Ogita","Tsuyoshi Isawa","Hiroyuki Takenaka","Takashi Yamamoto","Tetsuya Ishikawa","Itaru Hisauchi","Kohei Wakabayashi","Yuko Onishi","Kiyoshi Hibi","Kazuya Kawai","Ruka Yoshida","Hiroshi Suzuki","Gaku Nakazawa","Takanori Kusuyama","Itsuro Morishima","Koh Ono","Takeshi Kimura"],"significance":8,"published":"2024-02-20","source_date":"2024-02-20","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The STOPDAPT-3 trial tested an aspirin-free strategy (prasugrel monotherapy from day 1) versus standard DAPT after PCI. While the aspirin-free approach was noninferior for a net clinical benefit endpoint, the study raised questions about the bleeding-ischemia trade-off with immediate aspirin omission.","created":"2026-07-03T10:30:47Z","updated":"2026-07-03T13:29:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De STOPDAPT-3-trial vergeleek een aspirinevrij regime (prasugrel monotherapie) met standaard DAPT na PCI. Het aspirinevrije regime was non-inferieur voor bloedingen maar niet voor ischemische events. De resultaten ondersteunen dat aspirine vooralsnog onderdeel blijft van DAPT.","abstract_original":"BACKGROUND: Bleeding rates on dual antiplatelet therapy (DAPT) within 1 month after percutaneous coronary intervention (PCI) remain high in clinical practice, particularly in patients with acute coronary syndrome or high bleeding risk. Aspirin-free strategy might result in lower bleeding early after PCI without increasing cardiovascular events, but its efficacy and safety have not yet been proven in randomized trials. METHODS: We randomly assigned 6002 patients with acute coronary syndrome or high bleeding risk just before PCI either to prasugrel (3.75 mg/day) monotherapy or to DAPT with aspirin (81-100 mg/day) and prasugrel (3.75 mg/day) after loading of 20 mg of prasugrel in both groups. The coprimary end points were major bleeding (Bleeding Academic Research Consortium 3 or 5) for superiority and cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke) for noninferiority with a relative 50% margin. RESULTS: The full analysis set population consisted of 5966 patients (no-aspirin group, 2984 patients; DAPT group, 2982 patients; age, 71.6±11.7 years; men, 76.6%; acute coronary syndrome, 75.0%). Within 7 days before randomization, aspirin alone, aspirin with P2Y12 inhibitor, oral anticoagulants, and intravenous heparin infusion were given in 21.3%, 6.4%, 8.9%, and 24.5%, respectively. Adherence to the protocol-specified antiplatelet therapy was 88% in both groups at 1 month. At 1 month, the no-aspirin group was not superior to the DAPT group for the coprimary bleeding end point (4.47% and 4.71%; hazard ratio, 0.95 [95% CI, 0.75-1.20]; Psuperiority=0.66). The no-aspirin group was noninferior to the DAPT group for the coprimary cardiovascular end point (4.12% and 3.69%; hazard ratio, 1.12 [95% CI, 0.87-1.45]; Pnoninferiority=0.01). There was no difference in net adverse clinical outcomes and each component of coprimary cardiovascular end point. There was an excess of any unplanned coronary revascularization (1.05% and 0.57%; hazard ratio, 1.83 [95%CI, 1.01-3.30]) and subacute definite or probable stent thrombosis (0.58% and 0.17%; hazard ratio, 3.40 [95% CI, 1.26-9.23]) in the no-aspirin group compared with the DAPT group. CONCLUSIONS: The aspirin-free strategy using low-dose prasugrel compared with the DAPT strategy failed to attest superiority for major bleeding within 1 month after PCI but was noninferior for cardiovascular events within 1 month after PCI. However, the aspirin-free strategy was associated with a signal suggesting an excess of coronary events. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04609111."}