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February 24, 2025Thrombosis and Haemostasis

Clopidogrel monotherapy was associated with significantly lower all-cause mortality compared with prolonged DAPT, driving reductions in net adverse clinical events (NACE) and combined ischemic endpoints.

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Why the study?

Managing antiplatelet therapy after PCI in patients with concurrent high ischemic and bleeding risks is challenging, and whether transitioning to monotherapy after standard DAPT sufficiently mitigates ischemic events remains unclear.

Does clopidogrel monotherapy improve outcomes compared to prolonged DAPT in PCI patients with concurrent high ischemic and bleeding risk?

Population

1,003 PCI patients with high ischemic and bleeding risk in South Korea

Comparison

Clopidogrel monotherapy vs aspirin monotherapy vs continued DAPT after 12 ± 3 months of DAPT

Design

Multicenter registry-based observational study

Follow-up

Median 3.2 years

Authors

MMMaria Sara MauroDCDavide Capodanno

Discussion

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Member takes

Overview

Should not yet change DAPT practice in high-risk PCI; leaves open need for randomized confirmation.

Structured PICO

Does clopidogrel monotherapy improve outcomes compared to prolonged DAPT in PCI patients with concurrent high ischemic and bleeding risk?

P
Population
1,003 patients undergoing percutaneous coronary intervention (PCI) with concurrent high ischemic risk (DAPT score ≥2 or CHIP criteria) and high bleeding risk (ARC-HBR criteria)
I
Intervention
Clopidogrel monotherapy or aspirin monotherapy after 12 ± 3 months of dual antiplatelet therapy (DAPT)
C
Comparator
Continued dual antiplatelet therapy (DAPT) after 12 ± 3 months
O
Outcome
All-cause mortality, net adverse clinical events (NACE), combined ischemic endpoints, bleeding, myocardial infarction (MI), and strokehard clinical

In PCI patients with concurrent high ischemic and bleeding risk, transitioning to clopidogrel monotherapy after 12 months of DAPT may reduce all-cause mortality and net adverse clinical events compared to prolonged DAPT.

Limitations

  • Conducted exclusively in South Korea, limiting generalizability
  • Clopidogrel was the sole P2Y12 inhibitor assessed
  • Observational design prone to unavoidable bias
  • Patients on oral anticoagulants were excluded
  • Patients with CCS or ACS were analyzed together despite differing guideline recommendations

Cite This Study

Mauro et al. (2025) studied this question.

synapsesocial.com/papers/6a87e8d43f31f6b699bb6c8dhttps://doi.org/10.1055/a-2544-6263
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Optimal Long-term Antiplatelet Regimen for Patients with High Ischaemic and Bleeding Risks After Percutaneous Coronary Intervention2024 · 3 citations
  2. 2Bleeding and Thrombotic Trade-off in Dual-Risk Patients Undergoing Percutaneous Coronary Intervention2026 · 1 citations
  3. 3Personalized Antithrombotic Therapy After Percutaneous Coronary Intervention: A Systematic Review of Risk‐Stratified Approaches2026
  4. 4Antithrombotic therapy for secondary prevention in patients with acute coronary syndromes treated with percutaneous coronary intervention: options for personalization to reduce bleeding or ischaemic risks. A Clinical Consensus Statement of the ESC Working Group on Thrombosis, the Association for Acute CardioVascular Care of the ESC, the European Association of Percutaneous Cardiovascular Interventions of the ESC, and the ESC Working Group on Cardiovascular Pharmacology A Clinical Consensus Statement of the ESC Working Group on Thrombosis, the Association for Acute CardioVascular Care of the ESC, the European Association of Percutaneous Cardiovascular Interventions of the ESC, and the ESC Working Group on Cardiovascular Pharmacology.2026
  5. 5Antithrombotic therapy for secondary prevention in patients with acute coronary syndromes treated with percutaneous coronary intervention: options for personalization to reduce bleeding or ischaemic risks2026 · 1 citations