Key result
Clopidogrel monotherapy reduces MI ~29% vs aspirin in ACS patients post-PCI without increasing death or stroke.
Why the study?
The optimal antiplatelet monotherapy agent post-dual antiplatelet therapy after PCI in patients with ACS remains unclear, with comparative effectiveness and safety between clopidogrel and aspirin not fully established.
Does clopidogrel monotherapy reduce all-cause death, MI, and ischemic stroke compared to aspirin monotherapy in adult ACS patients post-PCI?
Meta-Analysis (n=16,056)
Does clopidogrel monotherapy reduce all-cause death, MI, and ischemic stroke compared to aspirin monotherapy in adult ACS patients post-PCI?
Relative Risk: 0.71 (95% CI 0.55–0.92)
p-value: p=0.01
In patients with ACS post-PCI, clopidogrel monotherapy significantly reduces MI and target-vessel revascularization compared to aspirin monotherapy, without increasing the risk of death or stroke.
Clopidogrel may be preferred over aspirin for post-PCI monotherapy in ACS to reduce MI; extends RCT meta-analysis confirmation of ischemic benefit without mortality or stroke differences.
Dual antiplatelet therapy is a standard treatment after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), but the optimal monotherapy agent post-dual antiplatelet therapy remains unclear. Clopidogrel and aspirin are widely used, yet their comparative effectiveness and safety in this patient population have not been fully established. This systematic review and meta-analysis compared the efficacy and safety of clopidogrel and aspirin monotherapy following PCI in patients with ACS. A comprehensive search of PubMed, Embase, and Web of Science was conducted from inception to March 31, 2025. Randomized controlled trials (RCTs) comparing clopidogrel and aspirin monotherapy in adult ACS patients post-PCI were included. Primary outcomes were all-cause death, myocardial infarction (MI), and ischemic stroke. Secondary outcomes included target-vessel and target-lesion revascularization, cardiovascular and noncardiovascular death, and stent thrombosis. The risk of bias was assessed using the Cochrane RoB 2 tool, and the GRADE methodology was applied to evaluate the certainty of evidence. Three RCTs involving 16,056 patients (clopidogrel: 8103; aspirin: 7953) were included. Clopidogrel significantly reduced MI (risk ratio = 0.71; 95% confidence interval: 0.55-0.92; P = 0.01) and target-vessel revascularization (risk ratio = 0.77; 95% confidence interval: 0.60-0.97; P = 0.03). No significant differences were found in all-cause death, ischemic stroke, or other secondary outcomes. Sensitivity analysis suggested a potential reduction in noncardiovascular death favoring clopidogrel. Clopidogrel monotherapy after PCI may offer superior protection against MI and target-vessel revascularization compared with aspirin, with no increased risk of death or stroke.
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Ali et al. (2025) conducted a meta-analysis in Acute coronary syndrome post-percutaneous coronary intervention (n=16,056). Clopidogrel monotherapy vs. Aspirin monotherapy was evaluated on Myocardial infarction (MI) (RR 0.71, 95% CI 0.55-0.92, p=0.01). Clopidogrel monotherapy significantly reduced myocardial infarction compared with aspirin (RR 0.71; 95% CI 0.55-0.92; P=0.01) in ACS patients post-PCI, with no increased risk of death or stroke.
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