Comparative outcomes of clopidogrel vs aspirin monotherapy in post-PCI patients: An updated systematic review and meta-analysis

Current guidelines recommend 6–12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention(PCI) followed by aspirinin monotherapy indefinitely. We aimed to assess efficacy and safety of Clopidogrel as compared to aspirin in patients undrgoing PCI after completing DAPT. We systematically searched 3 electronic databases and identified studies comparing clopidogrel to aspirin in post PCI population after completing DAPT. We included 7 studies with 20,360 patients. We pooled outcomes for major adverse cardiac events (MACE), typically comprising a composite of death, myocardial infarction (MI), or stroke; all-cause mortality; cardiac death; major bleeding; any stroke; ischemic stroke; hemorrhagic stroke; repeat revascularization; target-vessel revascularization (TVR); and definite stent thrombosis. Mean follow up was 12–36 months. Duration of DAPT was 1–18 months. Clopidogrel was associated with reductions in MACE than aspirin (RR: 0.82; 95 % CI: 0.69–0.98; p = 0.03), showed reduced risk of MI (RR 0.93 CI 0.60–1.44; p 0.74, I 2 63%) indicating a relative reduction of 7 %, reduced strokes numerically but non-significantly (RR: 0.72; 95 % CI: 0.48–1.07; p = 0.11), RRR 28 %, all cause mortality did not exhibit a significant difference between clopidogrel and aspirin (RR: 0.99; 95 % CI: 0.67–1.44; p = 0.94). Cardiac death (RR: 0.81; 95 % CI: 0.56–1.17; p = 0.26), major bleeding (RR: 0.90; 95 % CI: 0.61–1.33; p = 0.61), reflecting a 10 % non-significant relative reduction, repeat revascularization showed no significant difference (RR: 0.95; 95 % CI: 0.74–1.23; p = 0.72) representing a slight 5 % relative reduction, target vessel revascularization did not reveal any significant differences (RR: 0.89; 95 % CI: 0.69–1.16; p = 0.40) corresponding to a non-significant relative risk reduction of 11 %, stent thrombosis demonstrated no statistically significant difference (RR: 0.78; 95 % CI: 0.27–2.31; p = 0.66) RRR of 22 %. Compared to aspirin Clopidogrel was associated with reduction in MACE with no significant differences in Mortality, Major bleeding, MI, and repeat revascularization between groups. Prospero Registration Number CRD420251042349.