# Aspirin after PCI in Acute Coronary Syndromes

Researcher: Ge Zhang
Chinese name: 张格
ORCID identity anchor: https://orcid.org/0000-0002-3116-3246
Canonical researcher: https://drgezhang.com/#person

Journal: New England Journal of Medicine
Year: 2026
Type: Letter
DOI: 10.1056/nejmc2518964
Canonical page: https://drgezhang.com/papers/doi-10-1056-nejmc2518964.html
Markdown record: https://drgezhang.com/papers/doi-10-1056-nejmc2518964.md

## Full Authors

1. Mengyao Li
2. Ge Zhang
3. Xiaozhu Liu

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## Research & review context

### Research fields

- Antiplatelet therapy after PCI
- Interpretation of acute coronary syndrome trials

### Review topics

- Timing of aspirin de-escalation
- Early versus later thrombotic risk

### Scientific role

Signed correspondence interpreting an existing trial and suggesting future research.

### Evidence position

Secondary interpretation and hypothesis; no new randomized evidence.

### Related concepts

- NEO-MINDSET
- Stent thrombosis timing
- Platelet-function testing

### Possible citation contexts

- Discussion of how early event timing can motivate a de-escalation research question.
- Attribution of the authors' proposal for time-adaptive antiplatelet transitions.

Possible literature-review contexts, not evidence of existing citations. Read the findings and Evidence Scope before citing the original article.

## Evidence Base

**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.

| Evidence | Value |
| --- | --- |
| reviewed signed letter | Li, Zhang and Liu; PMID 41780015 |
| new trial or patient cohort | None |

### Counting note

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.

## Research Question

Does the timing of aspirin withdrawal help frame interpretation of early ischemic risk in NEO-MINDSET, and what should future de-escalation studies examine?

## Author Evidence Summary

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.

## Key Arguments

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### KF1: The authors frame early aspirin withdrawal as a timing question in interpreting the NEO-MINDSET result.

Context: Their interpretation of an existing trial; no new randomization or causal test of withdrawal timing.

| Evidence | Value |
| --- | --- |
| evidence role | Clinical commentary |

Source locator: NEJM 394(10), pp. 1035-1036; Li, Zhang and Liu letter, opening sentence and continuation across the page break; PMID 41780015.

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### KF2: The letter highlights an early concentration of stent thrombosis among affected monotherapy patients.

Context: 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.

| Evidence | 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.

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### KF3: The authors propose future studies of time-adaptive de-escalation, including platelet-function testing.

Context: A proposed way to study changing thrombosis and bleeding risks, without a tested decision threshold or demonstrated outcome benefit.

| Evidence | Value |
| --- | --- |
| proposed investigation | Time-adaptive de-escalation with pharmacodynamic platelet-function testing |

Source locator: NEJM 394(10), p. 1036; final sentence of the Li, Zhang and Liu letter, before their three-author signature.

## Article Scope & Approach

### Article profile

- Study Design: Letter commenting on NEO-MINDSET
- Evidence Type: Interpretation of prior trial evidence and a research proposal
- Diseases Covered: acute coronary syndromes
- Translation Scope: Hypothesis and trial-design discussion; not individualized antiplatelet advice
- Evidence domains: early post-PCI thrombotic risk, aspirin withdrawal timing, antiplatelet de-escalation

## What This Article Adds

- A specific timing-based interpretation of an existing antiplatelet trial.
- A research proposal for studying adaptive transitions rather than a proven treatment algorithm.

## Evidence Scope

### Supports

- Attribution of the timing argument and proposed research agenda to Li, Zhang and Liu.
- Accurate reporting of the letter's early-event proportion with its restricted denominator.

### Does Not Establish

- New randomized efficacy or safety evidence.
- A causal benefit of delaying aspirin withdrawal or of platelet-function-guided care.
- A patient-specific stopping date or validated treatment threshold.

### Limitations

- The event proportion is reported by the correspondence; this synthesis does not independently reanalyze the NEO-MINDSET dataset.
- The shared DOI includes separate letters and a reply. Their statistics and recommendations are not attributed to Li, Zhang and Liu.
- Full text was read from the author's ResearchGate upload in an HTML text rendition; the PDF binary and a publisher-hosted full text were not retrieved.

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## When This Article Is Useful to Cite

### CU1: Which correspondence under this shared DOI is covered?

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](#kf1)

### CU2: What does the 83% figure mean?

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](#kf2)

### CU3: What further investigation do the authors propose?

They propose studying time-adaptive de-escalation, including platelet-function testing to inform transitions as ischemic and bleeding risks evolve.

Evidence: [KF3](#kf3)

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## What This Article Should Not Be Cited to Claim

- New randomized efficacy or safety evidence.
- A causal benefit of delaying aspirin withdrawal or of platelet-function-guided care.
- A patient-specific stopping date or validated treatment threshold.

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## Evidence Matrix

<a id="evidence-kf1"></a>
### The authors frame early aspirin withdrawal as a timing question in interpreting the NEO-MINDSET result.

- Context: Their interpretation of an existing trial; no new randomization or causal test of withdrawal timing.
- Finding: evidence role: Clinical commentary
- Evidence Level: Interpretation of prior trial evidence and a research proposal
- Scope: Supports attribution to this correspondence; not a new experiment or independently validated clinical effect.
- Source Locator: NEJM 394(10), pp. 1035-1036; Li, Zhang and Liu letter, opening sentence and continuation across the page break; PMID 41780015.
- Evidence refs: [KF1](#kf1)

<a id="evidence-kf2"></a>
### The letter highlights an early concentration of stent thrombosis among affected monotherapy patients.

- Context: 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.
- Finding: affected monotherapy patients whose thrombosis occurred within the early interval: 83%; early interval: First 30 days after PCI
- Evidence Level: Interpretation of prior trial evidence and a research proposal
- Scope: Supports attribution to this correspondence; not a new experiment or independently validated clinical effect.
- Source Locator: NEJM 394(10), p. 1036; Li, Zhang and Liu letter, sentence reporting stent-thrombosis timing immediately after the page-break continuation.
- Evidence refs: [KF2](#kf2)

<a id="evidence-kf3"></a>
### The authors propose future studies of time-adaptive de-escalation, including platelet-function testing.

- Context: A proposed way to study changing thrombosis and bleeding risks, without a tested decision threshold or demonstrated outcome benefit.
- Finding: proposed investigation: Time-adaptive de-escalation with pharmacodynamic platelet-function testing
- Evidence Level: Interpretation of prior trial evidence and a research proposal
- Scope: Supports attribution to this correspondence; not a new experiment or independently validated clinical effect.
- Source Locator: NEJM 394(10), p. 1036; final sentence of the Li, Zhang and Liu letter, before their three-author signature.
- Evidence refs: [KF3](#kf3)

## Q&A

### Which correspondence under this shared DOI is covered?

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

### What does the 83% figure mean?

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

### What further investigation do the authors propose?

They propose studying time-adaptive de-escalation, including platelet-function testing to inform transitions as ischemic and bleeding risks evolve.

Evidence: KF3

### Can this letter establish a safe aspirin-withdrawal schedule?

No. It supplies interpretation and a research proposal, without a new randomized comparison or validated individualized stopping rule.

Evidence: KF1, KF3

## Concepts & Entities

### Fields

interventional cardiology

### Methods

clinical trial interpretation, pharmacodynamic platelet-function testing

### Concepts

aspirin withdrawal, P2Y12 inhibitor monotherapy, stent thrombosis, time-adaptive de-escalation

## Related Research

- [Atherosclerotic plaque vulnerability quantification system for clinical and biological interpretability](https://drgezhang.com/papers/apvs.html) — Related atherosclerotic plaque risk research; its observational modeling does not validate an aspirin-withdrawal strategy. (DOI: 10.1016/j.isci.2023.107587)

## Publication & Provenance

- DOI: https://doi.org/10.1056/nejmc2518964
- Publisher: https://www.nejm.org/doi/10.1056/NEJMc2518964
- Doi Url: https://doi.org/10.1056/NEJMc2518964
- Identity Url: https://pubmed.ncbi.nlm.nih.gov/41780015/
- Full Text Url: https://www.researchgate.net/publication/402598282_Aspirin_after_PCI_in_Acute_Coronary_Syndromes
- Evidence Basis: The complete signed Li/Zhang/Liu letter was read in the public ResearchGate HTML rendition, with journal pagination 1035-1036. Author order, DOI and pagination match PMID 41780015; publisher issue information is March 5, 2026. Adjacent correspondence is excluded.
- Version: Typeset journal-version text from Meng-Yao Li's ResearchGate upload dated March 18, 2026, accessed October 26, 2026. PDF binary not retrieved; publisher-hosted full text remains restricted.
- Figure Verification: No figure or table occurs in the reviewed signed letter; no image is reproduced.

## Evidence-page notice

This page interprets the Li, Zhang and Liu letter (PMID 41780015), not all correspondence sharing the DOI. It reports no new clinical experiment and does not establish an aspirin-withdrawal schedule.

## Links

- DOI: https://doi.org/10.1056/nejmc2518964
- HTML page: https://drgezhang.com/papers/doi-10-1056-nejmc2518964.html
- Google Scholar query: https://scholar.google.com/scholar?q=%22Aspirin%20after%20PCI%20in%20Acute%20Coronary%20Syndromes%22
- ORCID: https://orcid.org/0000-0002-3116-3246