This review evaluates the strategy of aspirin withdrawal in patients with coronary artery disease (CAD), covering pharmacologic rationale, clinical trial evidence, and guideline recommendations across settings including ACS, PCI, and concomitant oral anticoagulation (OAC) use (~15% of CAD patients).
Aspirin withdrawal after a brief period of dual antiplatelet or combination antithrombotic therapy reduces bleeding risk; efficacy and safety vary by clinical setting, timing of discontinuation, patient profile (age, sex, ethnicity, genetics, comorbidities), and choice of adjunctive therapy (OAC or P2Y12 inhibitor).
This is a narrative review without a systematic search or meta-analysis, limiting the strength of evidence synthesis. No new primary data are presented. Generalizability may be affected by variation in trials across patient populations and antithrombotic regimens.
In CAD patients on OAC, dropping aspirin early reduces bleeding without clear ischemic harm — consider aspirin withdrawal after a short course of combination therapy, tailoring the decision to individual bleeding risk, P2Y12 inhibitor choice, and timing post-ACS/PCI.
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