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Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Long-term outcomes of antiplatelet monotherapy post-percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remain incompletely understood.
  • The HOST-EXAM Extended study provides crucial post-trial follow-up data on antiplatelet monotherapy strategies.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of clopidogrel monotherapy versus aspirin monotherapy in patients after PCI with DES.
  • To compare composite net clinical outcomes, thrombotic events, and bleeding events between clopidogrel and aspirin monotherapy groups.

Main Methods:

  • 5438 patients with DES-PCI, event-free on dual antiplatelet therapy for 12±6 months, were randomized to clopidogrel or aspirin monotherapy.
  • Primary endpoint: composite of death, myocardial infarction, stroke, ACS readmission, and BARC ≥3 bleeding.
  • Secondary endpoints: thrombotic and bleeding events analyzed over an extended follow-up period.

Main Results:

  • Clopidogrel monotherapy showed a significantly lower rate of the primary composite endpoint (12.8% vs. 16.9%; HR 0.74, P<0.001) over median 5.8 years.
  • Reduced risks observed for secondary thrombotic (HR 0.66, P<0.001) and bleeding endpoints (HR 0.74, P=0.016) with clopidogrel.
  • No significant difference in all-cause mortality between groups (P=0.742); clopidogrel's benefit was consistent long-term.

Conclusions:

  • Clopidogrel monotherapy is associated with superior long-term net clinical outcomes compared to aspirin monotherapy in select PCI patients.
  • The findings support clopidogrel monotherapy as a potentially more effective strategy for reducing ischemic events while managing bleeding risk post-PCI.