Why the study?
Following dual antiplatelet therapy after PCI, the comparative effectiveness of clopidogrel versus aspirin monotherapy required assessment.
Does clopidogrel monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy in patients who have completed DAPT following PCI?
Does clopidogrel monotherapy reduce major adverse cardiovascular events compared to aspirin monotherapy in patients who have completed DAPT following PCI?
Following completion of DAPT post-PCI, clopidogrel monotherapy significantly reduces the risk of MACE, MI, and ischemic stroke compared to aspirin, without increasing the risk of major bleeding.
Answers are grounded in this paper and cite their sources.
Supports clopidogrel monotherapy after DAPT post-PCI; extends RCT evidence favoring P2Y12 inhibition over aspirin.
Background: Coronary artery disease (CAD) is the leading cause of death worldwide. After percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) is recommended to reduce thrombotic events. This meta-analysis assesses the effectiveness of clopidogrel compared to aspirin monotherapy following DAPT post-PCI. Methods: From inception to April 2025, an exhaustive literature search was conducted across electronic databases, including PubMed, Cochrane Library, ScienceDirect, EMBASE, and Web of Science. Risk ratios (RRs) along with 95% confidence intervals (CIs) were pooled using the random-effects model in Review Manager. Leave-one-out sensitivity analysis and funnel plots were used to evaluate heterogeneity and publication bias, respectively. Results: Six studies, including 3 RCTs and 3 observational studies, spanning over 19 494 patients, were included in our analysis. Clopidogrel significantly reduced major adverse cardiovascular events (MACE) (RR = 0.78; 95% CI: [0.69, 0.89]; P = .0002; I 2 = 0%) and myocardial infarction (MI) (RR = 0.73; 95% CI: [0.56, 0.94]; P = .02; I 2 = 21%) compared to aspirin. Likewise, the clopidogrel group demonstrated a substantial advantage in reducing the incidence of any stroke (RR = 0.66; 95% CI: [0.49, 0.89]; P = .006; I 2 = 14%), including ischemic stroke (RR = 0.69; 95% CI: [0.49, 0.97]; P = .04; I 2 = 0%). All other endpoints, including hemorrhagic stroke, all-cause mortality, cardiac death, major bleeding, stent thrombosis, repeat, and target vessel revascularization, were comparable between the 2 arms. Conclusion: Clopidogrel significantly reduced the incidence of MACE, MI, and stroke after DAPT following PCI compared to aspirin, indicating greater effectiveness. However, the main conclusion of this meta-analysis depends primarily on the estimates from RCTs. Additional randomized studies are necessary to confirm these results and support clinical decision-making.
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Cheema et al. (2026) studied this question.
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