Continuing aspirin monotherapy for patients with previous drug-eluting stents (DES) who are undergoing low-to-intermediate risk noncardiac surgery did not significantly reduce ischemic events compared with temporarily holding all antiplatelet therapy before the surgery, according to findings from the ASSURE DES trial presented at ESC Congress 2024 in London and simultaneously published in JACC.

Do-Yoon Kang, MD, et al., randomly assigned 926 patients in Korea who were undergoing elective noncardiac surgery and had received a DES more than a year prior to either continuing with aspirin (n=462) or to discontinue all antiplatelet therapy five days before their surgery (n=464). All told, the primary composite outcome of death from any cause, myocardial infarction, stent thrombosis, or stroke between five days before and 30 days after noncardiac surgery occurred in three patients (0.6% in the aspirin monotherapy group) and four patients (0.9% in the no antiplatelet group).

In other findings, researchers observed no stent thrombosis in either group and no significant differences in the incidence of major bleeding. However, minor bleeding was significantly more frequent in the aspirin group (14.9% vs. 10.1%, respectively). Event rates were also lower than expected, according to Principal Investigator Jung-Min Ahn, MD, potentially reflecting the improved safety profile of contemporary DES. "This low event rate led to the trial being underpowered and our overall findings should be interpreted with caution," he said.

In a related editorial comment published in JACC, Dominick J. Angiolillo, MD, PhD, FACC, said the trial's findings are encouraging "and a testament to important advancements in stent safety." However, he echoes the cautions about making any changes to current practice, given the low event rates, study design and types of surgeries performed. "With few exceptions, maintaining aspirin therapy and abiding by practice guidelines should remain the approach of choice for most PCI patients undergoing [non-cardiac surgery] until further high-quality data emerge," he writes.