Do you favor aspirin or P2Y12 inhibitor monotherapy following completion of 12 months of DAPT post-PCI in patients with elevated bleeding risk?

You could tailor based on bleeding risk.

If prior upper GI bleed or symptoms - p2y12.

If lower GI bleeds - aspirin.

The field is moving towards p2y12 monotherapy.

Also as mentioned should do genetic testing if thinking long-term clopidogrel monotherapy.

I would favor clopidogrel alone at this point since ASA is associated with a higher risk of GI bleeding. However, if the patient had severe 3-vessel disease and incomplete revascularization and is tolerating dual antiplatelet Rx then I would continue the combination therapy.

Agree with clopidogrel monotherapy at this point. It is generally a like-for-like replacement for ASA minus the GI cox 1-related side effects.

Guidelines recommend discontinuing antiplatelet therapy after one year.

I am slowly switching from Aspirin monotherapy to Clopidogrel monotherapy 12 months following revascularization. I also always check CYP2C19 metabolizer status before making the switch to Clopidogrel monotherapy.