Discontinuing Aspirin After Short Term Use Versus Continuous Use with a P2Y12 Inhibitor for the Treatment of Patients with Type 2 Diabetes Mellitus Following Percutaneous Coronary Intervention: A Meta-analysis

INTRODUCTION: In this analysis, we aimed to compare the efficacy and safety of discontinuing aspirin (ASA) after short-term use versus its continuous use with a P2Y12 inhibitor for the treatment of patients with type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI). METHODS: From May to June 2020, electronic databases were searched for related publications. The cardiovascular and bleeding outcomes representing efficacy and safety, respectively, were the endpoints of this study. The new RevMan software version 5.4 was used to analyze the data. Risk ratios (RR) and 95% confidence intervals (CI) were used to represent the results following data analysis. RESULTS: A total of 9774 participants with T2DM were included in this analysis, whereby 4941 patients were assigned to the ASA discontinuation group and 4833 patients to the dual antiplatelet (DAPT) group. Our result showed that compared to a longer duration (12 months) of DAPT (ASA + P2Y12 inhibitor) use in these patients with T2DM, discontinuing ASA after short-term use (1–3 months) thereafter using only a P2Y12 inhibitor (mono-therapy) was not associated with a significant increase in the risk of major adverse cardiovascular and cerebrovascular events (RR 0.92, 95% CI 0.76–1.12; P = 0.39), myocardial infarction (RR 0.98, 95% CI 0.75–1.26; P = 0.86), all-cause mortality (RR 0.78, 95% CI 0.60–1.02; P = 0.07), cardiac death (RR 0.76, 95% CI 0.43–1.35; P = 0.35), stroke (RR 1.06, 95% CI 0.67–1.67; P = 0.80) and stent thrombosis (RR 0.98, 95% CI 0.58–1.65; P = 0.93). However, discontinuing ASA after short-term use in these patients with T2DM was associated with a lower risk of bleeding defined according to the Academic Research Consortium (BARC) type 2–5 (RR 0.55, 95% CI 0.41–0.73; P = 0.0001), and thrombolysis in myocardial infarction (TIMI) defined as major (RR 0.55, 95% CI 0.41–0.75; P = 0.0001) and minor bleeding (RR 0.58, 95% CI 0.43–0.78; P = 0.0004). CONCLUSION: Discontinuing ASA after short-term use for the treatment of patients with T2DM following PCI was not associated with any increased cardiovascular outcomes. Also, discontinuing ASA after short-term use and continuing the use of a P2Y12 inhibitor were somewhat safer in these patients with T2DM. Further research should follow.