# STOPDAPT-3: aspirinevrij versus standaard DAPT na coronaire stenting

*geplaatst 2024-02-20 · Algemeen · Circulation · doi 10.1161/CIRCULATIONAHA.123.066720 · https://hartvaat.nl/2024/02/20/stopdapt-3-aspirinevrij-versus-standaard-dapt-na-coronaire-stenting/*

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.

## English: An Aspirin-Free Versus Dual Antiplatelet Strategy for Coronary Stenting: STOPDAPT-3 Randomized Trial.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.123.066720. Bijgewerkt 2026-07-03T13:29:50Z. 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.