What question did this study set out to answer?

To compare the safety and efficacy of clopidogrel and aspirin monotherapy after PCI with drug-eluting stents.

April 1, 2026

Clopidogrel versus aspirin as long-term monotherapy after PCI with drug-eluting stents: a systematic review and meta-analysis

Q: What does this research mean for the field?

Clopidogrel monotherapy reduces MACCE by 30% compared to aspirin after PCI with drug-eluting stents, without increasing the risk of major bleeding. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Clopidogrel monotherapy reduced MACCE by 30% (RR 0.70) compared to aspirin after PCI with drug-eluting stents, without increasing the risk of major bleeding.

Key Points

To compare the safety and efficacy of clopidogrel and aspirin monotherapy after PCI with drug-eluting stents.
Conducted a systematic literature search until July 2025
Included 5 studies: 2 RCTs and 3 observational studies
Pooled estimates calculated using a random-effects model
Primary outcome: Major Adverse Cardiac and Cerebrovascular Events (MACCE)
Clopidogrel reduced MACCE by 30% compared to aspirin (RR: 0.70; p<0.0001)
Clopidogrel also reduced the risk of stroke and myocardial infarction significantly
Major bleeding and mortality rates were similar between the two medications

Structured PICO

Does clopidogrel monotherapy reduce MACCE compared to aspirin monotherapy in adults who have completed event-free DAPT following PCI with DES?

Population

17,010 adults who had undergone PCI with DES implantation and completed a standardized duration of event-free dual antiplatelet therapy (DAPT), pooled from 5 studies (2 RCTs, 3 observational)

Intervention

Clopidogrel monotherapy

Comparator

Aspirin monotherapy

Outcome

Major Adverse Cardiac and Cerebrovascular Events (MACCE)composite

In patients completing event-free DAPT after PCI with DES, long-term clopidogrel monotherapy significantly reduces MACCE, stroke, and MI compared to aspirin monotherapy without increasing major bleeding risk.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background The optimal long-term mono-antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains uncertain, with limited data comparing aspirin and clopidogrel monotherapy. Objectives This meta-analysis aims to compare the safety and efficacy of clopidogrel versus aspirin in patients who have completed a standardized duration of event-free dual antiplatelet therapy (DAPT) following PCI with DES. Methods A comprehensive literature search across major databases was conducted until july 2025 to identify relevant studies that compared clopidogrel monotherapy with aspirin monotherapy in adults who had undergone PCI with DES implantation. The primary outcome was Major Adverse Cardiac and Cerebrovascular Events (MACCE). Pooled estimates were calculated using a random-effects model. Results Five studies (2 RCTs, 3 observational; n = 17,010 patients) were included. Clopidogrel monotherapy was associated with a significant 30% reduction in MACCE compared to aspirin monotherapy (RR: 0.70; 95% CI: 0.59–0.83; p0.0001). Pooled analysis of hazard ratios (HR) demonstrated a similar benefit (HR: 0.68; 95% CI: 0.57-0.81; P0.0001). Incidence of Major bleeding, mortality, and cardiac death were comparable between the two groups (RR: 0.94; 95% CI: 0.57-1.54; P = 0.80), (RR 1.06, 95% CI 0.73-1.55), (RR 0.87, 95% CI 0.51-1.50), respectively. Notably, the analysis of adjusted HRs demonstrated that clopidogrel significantly reduced the risk of stroke (HR 0.58, 95% CI 0.38-0.88, p=0.009) and myocardial infarction (MI) (HR: 0.61; 95% CI: 0.43-0.87; P=0.005). Conclusion Clopidogrel was significantly associated with a reduction in MACCE, stroke, and MI, without a concomitant increase in major bleeding risk.

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