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December 10, 2024Thrombosis and Haemostasis

After IPTW adjustment, the clopidogrel monotherapy group showed a significantly lower rate of the primary endpoint than the DAPT group (HR = 2.09, 95% CI = 1.22–3.60, p = 0.008), with no statistical difference compared to aspirin monotherapy (HR = 1.46, 95% CI = 0.83–2.54, p = 0.187).

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Why the study?

The optimal long-term antiplatelet strategy in patients at both high ischaemic and bleeding risks after PCI needed assessment.

Does clopidogrel monotherapy improve clinical outcomes compared to aspirin monotherapy or DAPT in patients at high ischemic and bleeding risks after PCI?

Population

Patients at high risks of both ischaemia and bleeding after PCI

Comparison

Clopidogrel monotherapy vs aspirin monotherapy vs DAPT

Design

IPTW-adjusted observational cohort study

Follow-up

12-month

Authors

JJJeong Yoon JangYGYu. M. GainAJAhn Jongwha

Discussion

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Overview

Supports clopidogrel over aspirin for long-term secondary prevention in complex.

Structured PICO

Does clopidogrel monotherapy improve clinical outcomes compared to aspirin monotherapy or DAPT in patients at high ischemic and bleeding risks after PCI?

P
Population
2,703 patients at high risks of both ischemia and bleeding after percutaneous coronary intervention (PCI), excluding those with ischemic and major bleeding complications during the mandatory period of dual antiplatelet therapy (DAPT).
I
Intervention
Clopidogrel monotherapy
C
Comparator
Aspirin monotherapy or dual antiplatelet therapy (DAPT)
O
Outcome
Composite of all-cause death, myocardial infarction, stroke, or major bleeding for 12-month follow-up periodcomposite

In patients at high bleeding and ischemic risk after PCI, clopidogrel monotherapy demonstrated a significant net clinical benefit compared to DAPT, primarily driven by a lower incidence of ischemic events.

Cite This Study

Jang et al. (2024) studied this question.

synapsesocial.com/papers/6a8d2b2da658c8b40988dc9chttps://doi.org/10.1055/a-2499-5458
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Also Consider

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

  1. 1Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk2024 · 52 citations
  2. 2Antiplatelet Therapy in Percutaneous Coronary Intervention Patients with Concurrent High Ischemic and Bleeding Risk2025 · 2 citations
  3. 3Efficacy and Safety of Dual Antiplatelet Therapy in High-Risk, Post-Percutaneous Coronary Intervention Patients beyond One Year2025
  4. 4Clopidogrel versus aspirin monotherapy following dual antiplatelet therapy after percutaneous coronary intervention: an updated meta-analysis of 162,829 patients2026 · 2 citations
  5. 5Optimal antiplatelet therapy for acute coronary syndrome patients with high risk for both ischemia and bleeding2024