Clopidogrel monotherapy after PCI reduces MACE risk by 24% versus aspirin and lowers minor and GI bleeding, with less stroke risk compared to aspirin.
Does clopidogrel monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy for long-term secondary prevention after dual antiplatelet therapy following PCI?
In patients completing DAPT post-PCI, long-term clopidogrel monotherapy is superior to aspirin, significantly reducing MACE and stroke while lowering the risk of minor and gastrointestinal bleeding.
Absolute Event Rate: 0% vs 0%
Background: The optimal choice of antiplatelet monotherapy after dual antiplatelet therapy (DAPT) among patients undergoing PCI remains debatable. While aspirin has long been the default choice, clopidogrel has emerged as a potential alternative due to its lower bleeding risk and possible superior ischemic protection. This meta-analysis sought to investigate the recent findings comparing the use of aspirin against clopidogrel after different durations of DAPT in patients who underwent PCI. Methods: We searched for randomized controlled trials and cohort studies comparing long-term aspirin and clopidogrel monotherapy after DAPT post-PCI. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included major and minor bleeding, gastrointestinal (GI) bleeding, stroke, myocardial infarction (MI), target vessel revascularization, and stent thrombosis. Results: Six studies comprising 14,992 patients were included. Clopidogrel monotherapy was associated with a significantly lower risk of MACE than aspirin (risk ratio RR: 1.24; 95% CI: 1.09–1.42; P = .001). Aspirin monotherapy resulted in a higher risk of minor bleeding (RR: 1.57; 95% CI: 1.06–2.34; P = .03) and GI bleeding (RR: 1.19; 95% CI: 1.04–1.37; P = .01). However, aspirin monotherapy was associated with a higher risk of stroke, including both ischemic (RR: 1.56; 95% CI: 1.03–2.38; P = .04) and hemorrhagic stroke (RR: 2.06; 95% CI: 1.06–3.98; P = .03). Conclusion: Clopidogrel monotherapy appears to be a superior alternative to aspirin for long-term secondary prevention after PCI, offering a lower risk of MACE and stroke without increasing major bleeding or mortality. However, individual factors such as genetic variability, GI bleeding risk, and cost should guide therapy selection.
Moawad et al. (Fri,) reported a other. Clopidogrel monotherapy after PCI reduces MACE risk by 24% versus aspirin and lowers minor and GI bleeding, with less stroke risk compared to aspirin.