Key result
Low dose clopidogrel (50 mg/d) showed no significant difference in the composite risk of death, myocardial infarction, or stroke compared to standard dose clopidogrel (75 mg/d) in Chinese ACS patients after PCI (HR 1.345).
Why the study?
Continuation of SAPT is recommended after DAPT for ACS patients undergoing PCI, but the optimal long-term SAPT remains unclear.
Does low dose clopidogrel (50 mg/d) maintain comparable efficacy and safety to standard dose clopidogrel (75 mg/d) as single antiplatelet therapy in Chinese ACS patients undergoing PCI after DAPT?
Cohort (n=378)
No
Does low dose clopidogrel (50 mg/d) maintain comparable efficacy and safety to standard dose clopidogrel (75 mg/d) as single antiplatelet therapy in Chinese ACS patients undergoing PCI after DAPT?
A 50 mg/d maintenance dose of clopidogrel may offer comparable efficacy and safety to the standard 75 mg/d dose for Chinese ACS patients on single antiplatelet therapy after 12 months of DAPT.
Supports exploring 50 mg/d dosing; leaves open randomized confirmation of noninferiority in Chinese ACS patients post-DAPT.
Continuation of single antiplatelet treatment (SAPT) is recommended for patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after dual antiplatelet treatment (DAPT). However, the optimal long-term SAPT remains unclear for these patients. The retrospective study recruited ACS patients who underwent PCI and chosen clopidogrel to SAPT after DAPT between 01/2014 and 12/2016 at the Central Hospital of Wuhan, Wuhan, China. Patients were divided into 2 groups after standard DAPT: low dose group (clopidogrel, 50 mg/d) and control group (clopidogrel, 75 mg/d). Among 378 enrolled patients with ACS undergoing PCI, 49/378 (14.5%) were taking 50 mg clopidogrel after DAPT. At the mean follow-up of 34 months, the cumulative incidence of the primary outcomes (hazard ratio [HR] 1.345, 95% CI: 0.455-3.974; P = .592), secondary outcome (HR 1.483, 95% CI: 0.506-4.348; P = .473), and safety outcomes (HR 2.268, 95% CI: 0.835-6.160; P = .108) showed no significant differences between the 2 group. Propensity score-matched analysis confirmed these findings. A 50 mg maintenance dose of clopidogrel may be comparable to 75 mg clopidogrel for Chinese patients with ACS undergoing PCI after at least 12 months of DAPT in efficacy and safety.
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Cheng et al. (2025) conducted a cohort in Acute Coronary Syndromes (ACS) (n=378). Low dose clopidogrel (50 mg/d) vs. Standard dose clopidogrel (75 mg/d) was evaluated on Composite of time to first occurrence of any confirmed death, myocardial infarction (MI), and stroke (HR 1.345, 95% CI 0.455-3.974, p=0.592). Low dose clopidogrel (50 mg/d) showed no significant difference in the composite risk of death, myocardial infarction, or stroke compared to standard dose clopidogrel (75 mg/d) in Chinese ACS patients after PCI (HR 1.345).
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