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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Antiplatelet monotherapy in the chronic maintenance period after percutaneous coronary intervention (PCI) remains underexplored, particularly for patients with high bleeding risk (HBR) or complex PCI.
  • Optimizing antiplatelet strategies is crucial for balancing thrombotic risk and bleeding complications in these patient populations.

Purpose of the Study:

  • To compare the efficacy and safety of clopidogrel versus aspirin monotherapy in patients with HBR and/or complex PCI during the chronic maintenance phase.
  • To evaluate the impact of these antiplatelet strategies on both thrombotic events and bleeding complications.

Main Methods:

  • A post hoc analysis of the multicenter HOST-EXAM Extended study (NCT02044250) involving patients event-free on dual antiplatelet therapy (DAPT) for 6-18 months post-PCI.
  • Patients were randomized to clopidogrel or aspirin monotherapy, with analyses stratified by HBR and PCI complexity.
  • Coprimary endpoints included a composite of thrombotic events and any bleeding (BARC type 2-5).

Main Results:

  • Clopidogrel monotherapy demonstrated lower rates of thrombotic events compared to aspirin, with hazard ratios of 0.62 (non-HBR) and 0.49 (complex PCI).
  • Bleeding event rates were also consistently lower with clopidogrel compared to aspirin (HR 0.58 for non-HBR, HR 0.68 for non-complex PCI).
  • These benefits were observed regardless of the presence of HBR or PCI complexity, with no significant interaction effects.

Conclusions:

  • Clopidogrel monotherapy offers a consistent benefit over aspirin monotherapy in reducing thrombotic and bleeding events in patients post-PCI.
  • The findings support clopidogrel as a preferred agent for antiplatelet monotherapy in the chronic maintenance phase, especially for patients with HBR or complex PCI.
  • This strategy helps optimize the risk-benefit profile in long-term management of coronary artery disease.