Dropping aspirin early cuts bleeding. Who still needs it for clot protection?
The debate
7 clinicians quoted on the record
Continue ticagrelor alone. Bleeding falls with no clear rise in clots.
Keep aspirin a full year when the anatomy is high risk, especially on clopidogrel.
Where the experts land
0–0 on record · 7 unplaced
Stop aspirin at one month, P2Y12 inhibitor alone · 0
On the record, unplaced · 7
Keep both antiplatelets for 12 months · 0
“And we need to convince the people that the short DAPT regimen is the way forward. This is something I would like to emphasize. Whatever the type of monotherapy you're going to choose, you have to go for a short DAPT regimen.”
Who we found publicly on the record — a snapshot, not a poll of the field. Larger dots are deciders; dashed dots are scan-reported, not yet verified.
Where the field stands
Common ground
Everyone accepts that dropping aspirin early reduces clinically relevant bleeding.
The crux
Is one-month aspirin withdrawal the default after ACS, or only for ticagrelor and prasugrel patients?
Still unknown
Trials powered for ischemic events in highest-risk anatomy, plus a clearer read on clopidogrel monotherapy.
On the record
Their own words — position stated as published
Aspirin off at 1 month
“It is my belief that it’s time to change the guidelines and standard clinical practice such that we no longer treat most acute coronary artery syndrome (ACS) patients with dual antiplatelet therapy beyond one month after a successful PCI procedure.”
Gregg W. Stone · Professor of Medicine (Cardiology) · X ↗
Depends on P2Y12 agent
“For patients receiving a predictably high level of platelet P2Y12 inhibition, this has become clearer: most patients benefit from withdrawal of aspirin between 2 weeks and 3 months after PCI, followed by P2Y12 inhibitor monotherapy.”
Robert F. Storey · Professor of Cardiology · X ↗
Aspirin off at 1 month
“In low-risk acute MI patients with early complete revascularisation and no complications after one month of DAPT, switching to P2Y12 inhibitor monotherapy-maintained protection from ischaemic events and reduced bleeding.”
Giuseppe Tarantini · Professor · X ↗
Aspirin off at 1 month
“The appropriate clinical question is today no longer “Why shorten DAPT?”—but rather, “Why prolong it unnecessarily?””
Roxana Mehran · Interventional cardiologist · X ↗
Where do you land?
No votes yet — the measured split appears at 10.
Clinician takes
Sim smoke: after ULTIMATE-DAPT we stop aspirin at one month for most ACS patients on ticagrelor.
iOS Sim Dev· Stop aspirin at one month, P2Y12 inhibitor alone
Takes from signed-in Synapse members — a measured read of this board, not a representative poll of the field.
Where the evidence stands
What's settled
2What's still open
1How this gets settled
Resolving trial — not yet identified
Who could settle it
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Who this affects
Who could fund or run it
Institutions that could fund, run, or adopt
Sources & verification
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