New England Journal of Medicine
Does the timing of aspirin withdrawal help frame interpretation of early ischemic risk in NEO-MINDSET, and what should future de-escalation studies examine?
Li, Zhang and Liu interpret the NEO-MINDSET result through the timing of aspirin withdrawal. They highlight that 83% of monotherapy patients who had stent thrombosis experienced it within 30 days, as reported in their letter, and propose studying time-adaptive de-escalation and platelet-function testing. This is commentary on prior evidence, not a new trial or proof that testing-guided withdrawal improves outcomes. Only their signed letter is synthesized; the other letters and trialists' reply sharing this DOI are excluded.
Mengyao Li, Ge Zhang, Xiaozhu Liu. Aspirin after PCI in Acute Coronary Syndromes. New England Journal of Medicine. 2026;394(10):1035–1036. https://doi.org/10.1056/nejmc2518964
Aspirin after PCI in Acute Coronary Syndromes
A letter by Li, Zhang and Liu argues that the timing of aspirin withdrawal deserves further study after PCI; it provides no new randomized comparison or validated treatment rule.
The 83% figure describes when thrombosis occurred among monotherapy patients who had stent thrombosis, not the risk among all monotherapy patients. The authors do not introduce a new patient cohort.
Their interpretation of an existing trial; no new randomization or causal test of withdrawal timing.
Source locator: NEJM 394(10), pp. 1035-1036; Li, Zhang and Liu letter, opening sentence and continuation across the page break; PMID 41780015.
Among monotherapy patients who experienced stent thrombosis, the letter reports that it occurred in 83% within 30 days; this is not an 83% event rate in the entire treatment group.
| Measure | Value |
|---|---|
| affected monotherapy patients whose thrombosis occurred within the early interval | 83% |
| early interval | First 30 days after PCI |
Source locator: NEJM 394(10), p. 1036; Li, Zhang and Liu letter, sentence reporting stent-thrombosis timing immediately after the page-break continuation.
A proposed way to study changing thrombosis and bleeding risks, without a tested decision threshold or demonstrated outcome benefit.
Source locator: NEJM 394(10), p. 1036; final sentence of the Li, Zhang and Liu letter, before their three-author signature.
Only the letter signed by Mengyao Li, Ge Zhang and Xiaozhu Liu, indexed as PMID 41780015, is covered. Other letters and the trialists' reply are excluded.
Evidence: KF1
Among monotherapy patients who had stent thrombosis, the letter reports that 83% experienced it within 30 days. This is not the probability of thrombosis for every monotherapy patient.
Evidence: KF2
They propose studying time-adaptive de-escalation, including platelet-function testing to inform transitions as ischemic and bleeding risks evolve.
Evidence: KF3
| Row ID | Component | Context | Finding | Evidence Level | Scope | Source Locator | Evidence refs |
|---|---|---|---|---|---|---|---|
| evidence-kf1 | The authors frame early aspirin withdrawal as a timing question in interpreting the NEO-MINDSET result. | Their interpretation of an existing trial; no new randomization or causal test of withdrawal timing. | evidence role: Clinical commentary | Interpretation of prior trial evidence and a research proposal | Supports attribution to this correspondence; not a new experiment or independently validated clinical effect. | NEJM 394(10), pp. 1035-1036; Li, Zhang and Liu letter, opening sentence and continuation across the page break; PMID 41780015. | KF1 |
| evidence-kf2 | The letter highlights an early concentration of stent thrombosis among affected monotherapy patients. | Among monotherapy patients who experienced stent thrombosis, the letter reports that it occurred in 83% within 30 days; this is not an 83% event rate in the entire treatment group. | affected monotherapy patients whose thrombosis occurred within the early interval: 83%; early interval: First 30 days after PCI | Interpretation of prior trial evidence and a research proposal | Supports attribution to this correspondence; not a new experiment or independently validated clinical effect. | NEJM 394(10), p. 1036; Li, Zhang and Liu letter, sentence reporting stent-thrombosis timing immediately after the page-break continuation. | KF2 |
| evidence-kf3 | The authors propose future studies of time-adaptive de-escalation, including platelet-function testing. | A proposed way to study changing thrombosis and bleeding risks, without a tested decision threshold or demonstrated outcome benefit. | proposed investigation: Time-adaptive de-escalation with pharmacodynamic platelet-function testing | Interpretation of prior trial evidence and a research proposal | Supports attribution to this correspondence; not a new experiment or independently validated clinical effect. | NEJM 394(10), p. 1036; final sentence of the Li, Zhang and Liu letter, before their three-author signature. | KF3 |
Only the letter signed by Mengyao Li, Ge Zhang and Xiaozhu Liu, indexed as PMID 41780015, is covered. Other letters and the trialists' reply are excluded.
Evidence: KF1
Among monotherapy patients who had stent thrombosis, the letter reports that 83% experienced it within 30 days. This is not the probability of thrombosis for every monotherapy patient.
Evidence: KF2
They propose studying time-adaptive de-escalation, including platelet-function testing to inform transitions as ischemic and bleeding risks evolve.
Evidence: KF3
No. It supplies interpretation and a research proposal, without a new randomized comparison or validated individualized stopping rule.
Evidence: KF1, KF3
Study-level author-maintained evidence summary. Not participant-level data and not a ready-to-pool meta-analysis dataset. For formal citation, use the original article DOI.
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These records identify the same original work; database inclusion is not evidence of scientific validity or clinical benefit.