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Updated: Jun 13, 2025
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Published on: March 15, 2022
Aspirin vs. clopidogrel monotherapy beyond 1 month after complex percutaneous coronary intervention: a pre-specified
Takenori Domei1, Ko Yamamoto1, Masahiro Natsuaki2
1Department of Cardiology, Kokura Memorial Hospital, Kitakyushu 802-8555, Japan.
Insights
Aspirin monotherapy showed a lower risk of cardiovascular events compared to clopidogrel monotherapy after complex percutaneous coronary intervention (PCI). Bleeding risk was similar between aspirin and clopidogrel monotherapy regardless of PCI complexity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) duration is crucial after percutaneous coronary intervention (PCI).
- Short DAPT followed by monotherapy is an emerging strategy.
- Optimal monotherapy choice after complex PCI remains under investigation.
Purpose of the Study:
- To compare aspirin monotherapy versus P2Y12 inhibitor (clopidogrel) monotherapy following 1-month DAPT in patients undergoing complex PCI.
- To evaluate cardiovascular events and bleeding risk in this specific patient subgroup.
Main Methods:
- Subgroup analysis of the STOPDAPT-3 trial focusing on patients with complex PCI.
- Randomized comparison of 1-month DAPT followed by aspirin vs. 1-month DAPT followed by clopidogrel.
- Co-primary endpoints: cardiovascular events and major bleeding, assessed at 30-day landmark.
Main Results:
- A significant interaction was observed between complex PCI and treatment strategy for cardiovascular events (P=0.04).
- Aspirin monotherapy demonstrated a numerically lower risk of cardiovascular events in complex PCI patients (3.3% vs. 5.2%).
- No significant difference in bleeding events was found between aspirin and clopidogrel monotherapy, irrespective of PCI complexity.
Conclusions:
- Aspirin monotherapy may be favored over clopidogrel monotherapy in patients with complex PCI after short DAPT, regarding cardiovascular events.
- The choice between aspirin and clopidogrel monotherapy does not significantly impact bleeding risk in complex PCI patients.
- Further research is warranted to confirm these findings and optimize antiplatelet strategies post-complex PCI.
Aims:
There were no previous studies comparing aspirin vs. P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI).
Methods And Results:
We conducted a pre-specified subgroup analysis based on complex PCI in the 1-year results of the STOPDAPT-3 (ShorT and OPtimal Duration of Dual AntiPlatelet Therapy-3) trial, which randomly compared 1-month DAPT followed by aspirin monotherapy (aspirin group) with 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). The main analysis in the present study was the 30-day landmark analysis. The co-primary endpoints were cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding (Bleeding Academic Research Consortium 3 or 5). In the 30-day landmark analysis (N = 5833), there were 1415 patients (24.3%) who underwent complex PCI. There was a significant interaction between complex PCI and the effect of the aspirin group relative to the clopidogrel group for cardiovascular events (complex PCI: 3.3% vs. 5.2%, non-complex PCI: 4.3% vs. 3.6%, interaction P = 0.04) and net adverse clinical events (complex PCI: 4.8% vs. 7.2%, non-complex PCI: 5.3% vs. 4.4%, interaction P = 0.02), but not for bleeding events (complex PCI: 2.1% vs. 2.7%, non-complex PCI: 1.7% vs. 1.4%, interaction P = 0.35).
Conclusions:
There was a significant interaction between complex PCI and the effect of aspirin monotherapy relative to clopidogrel monotherapy beyond 1 month and up to 1 year for cardiovascular events due to numerically lower risk of aspirin monotherapy in patients with complex PCI, while the effect of aspirin monotherapy relative to clopidogrel monotherapy was not different for bleeding regardless of complex PCI.
Clinical Trial Registration:
ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111.
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