Less Bleeding by Omitting Aspirin in Non-ST-segment Elevation Acute Coronary Syndrome Patients (LEGACY)

<b>Rationale: </b>Dual antiplatelet therapy, consisting of aspirin and a P2Y12-inhibitor, reduces the risk of stent thrombosis, myocardial infarction and stroke after coronary stent implantation. Inevitably, it is also associated with a higher risk of (major) bleeding. Given the advances in stent properties, stenting implantation technique and pharmacology, it may be possible to treat patients with a single antiplatelet strategy by completely omitting aspirin. <b><br></b><b>Objective: </b>This study will assess whether omitting aspirin reduces the rate of major or minor bleeding while remaining non-inferior to the current standard of care with regards to ischemic events in patients with non-ST segment elevation acute coronary syndrome. <br><b>Study design: </b>Open-label, multicentre randomized controlled trial. <br><br><b>Study population:</b> Adult patients presenting with non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. <br><br><b>Intervention:</b> In the intervention group aspirin will be completely omitted from the antiplatelet regimen in the 12 months following PCI. <br><br><b>Main study endpoints: </b>The primary bleeding endpoint is major or minor bleeding defined as Bleeding Academic Research Consortium type 2, 3 or 5 bleeding at 12 months. The primary ischemic endpoint is ischemic events defined as the composite of all-cause death, myocardial infarction and stroke at 12 months. <br><br>