Key result
Aspirin monotherapy after DAPT carries ~51% higher stroke risk than clopidogrel.
Why the study?
Although aspirin is the traditional standard after stopping dual antiplatelet therapy following percutaneous coronary intervention, emerging evidence suggests clopidogrel monotherapy may offer comparable or better outcomes in coronary artery disease.
Does clopidogrel monotherapy reduce cardiovascular and bleeding outcomes compared to aspirin monotherapy in patients with coronary artery disease after discontinuation of dual antiplatelet therapy?
Meta-Analysis (n=15,000)
Does clopidogrel monotherapy reduce cardiovascular and bleeding outcomes compared to aspirin monotherapy in patients with coronary artery disease after discontinuation of dual antiplatelet therapy?
In patients with coronary artery disease completing dual antiplatelet therapy, clopidogrel monotherapy is associated with a lower risk of stroke compared to aspirin without increasing bleeding or other ischemic events, supporting its use as an alternative maintenance therapy.
Clopidogrel may be preferred over aspirin after DAPT to reduce stroke; challenges aspirin as standard monotherapy and warrants RCT confirmation.
Background: Aspirin has traditionally been the standard antiplatelet therapy after discontinuation of dual antiplatelet therapy following percutaneous coronary intervention. However, emerging evidence suggests that clopidogrel may offer comparable or potentially better outcomes. This study compared the efficacy and safety of aspirin versus clopidogrel monotherapy in patients with coronary artery disease. Methods: We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD420251101793). PubMed, Google Scholar, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials and observational studies comparing aspirin with clopidogrel monotherapy after dual antiplatelet therapy. Outcomes included myocardial infarction, stroke, major and minor bleeding, cardiovascular mortality, revascularization, and stent thrombosis. Risk ratios with 95% confidence intervals were pooled using a random-effects model. Results: Seven studies involving more than 15,000 patients were included. Aspirin was associated with a significantly higher risk of stroke than clopidogrel (RR 1.51, 95% CI 1.06–2.15, P = 0.024). No significant differences were observed in myocardial infarction (RR 1.06, 95% CI 0.74–1.53, P = 0.738), major bleeding (RR 1.16, 95% CI 0.78–1.75, P = 0.463), minor bleeding (RR 1.43, 95% CI 0.72–2.82, P = 0.304), cardiovascular mortality (RR 1.14, 95% CI 0.87–1.50, P = 0.331), revascularization (RR 1.07, 95% CI 0.91–1.27, P = 0.401), or stent thrombosis (RR 1.53, 95% CI 0.81–2.89, P = 0.193). Conclusion: Clopidogrel and aspirin showed no significant differences in most evaluated outcomes after dual antiplatelet therapy. Clopidogrel was associated with a lower risk of stroke without a significant increase in major or minor bleeding, supporting its use as an alternative to aspirin for long-term maintenance therapy.
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Almutairi et al. (2026) conducted a meta-analysis in Coronary artery disease (n=15,000). Aspirin monotherapy vs. Clopidogrel monotherapy was evaluated on Stroke (RR 1.51, 95% CI 1.06-2.15, p=0.024). Aspirin monotherapy after DAPT was associated with a higher risk of stroke than clopidogrel (RR 1.51, 95% CI 1.06-2.15, P=0.024), with no significant differences in MI, mortality, or bleeding.
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