Related Experiment Video
Updated: Sep 19, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Aspirin vs Clopidogrel 1 Month After Acute Coronary Syndrome With High-Bleeding Risk or ST-Segment Elevation
Yuki Obayashi1, Masahiro Natsuaki2, Hirotoshi Watanabe3
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Insights
Aspirin and clopidogrel showed similar effectiveness and safety for acute coronary syndrome (ACS) patients after percutaneous coronary intervention. This holds true regardless of high bleeding risk (HBR) or ST-segment elevation myocardial infarction (STEMI) status.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- High bleeding risk (HBR) and acute coronary syndrome (ACS) subtypes, including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS), are crucial for determining optimal antiplatelet therapy.
- Choosing the right antiplatelet strategy is vital for managing ACS patients post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare the 1-year efficacy and safety of aspirin versus clopidogrel in ACS patients undergoing PCI.
- To analyze these effects based on subgroups: high bleeding risk (HBR) vs. non-HBR and STEMI vs. NSTE-ACS.
Main Methods:
- The study analyzed data from the Short and Optimal Duration of Dual Antiplatelet Therapy-3 (STOPDAPT-3) trial.
- Aspirin and clopidogrel monotherapy were compared beyond 30 days up to 1 year post-PCI.
- Coprimary endpoints included cardiovascular events (death, MI, stent thrombosis, stroke) and major bleeding (BARC 3 or 5).
Main Results:
- No statistically significant differences in cardiovascular endpoints were observed between aspirin and clopidogrel in HBR/non-HBR or STEMI/NSTE-ACS subgroups.
- Similarly, bleeding endpoint rates did not differ significantly between the two antiplatelet agents across these patient stratifications.
- Hazard ratios (HRs) for cardiovascular and bleeding endpoints showed no significant interaction with HBR or ACS subtype.
Conclusions:
- Aspirin and clopidogrel demonstrate comparable cardiovascular and bleeding outcomes in ACS patients up to 1 year post-PCI.
- These findings apply irrespective of high bleeding risk (HBR) status or ACS subtype (STEMI/NSTE-ACS).
- The study supports individualized antiplatelet therapy decisions based on patient-specific risk factors.
Background:
High bleeding risk (HBR) and acute coronary syndrome (ACS) subtypes (ST-segment elevation myocardial infarction [STEMI] and non-ST-segment elevation ACS [NSTE-ACS]) might be key determinants of appropriate antiplatelet strategies.
Objectives:
The aim of this study was to investigate the effects of aspirin versus clopidogrel within 1 year after percutaneous coronary intervention in patients with ACS, on the basis of HBR or non-HBR and STEMI or NSTE-ACS.
Methods:
Patients with ACS in the STOPDAPT-3 (Short and Optimal Duration of Dual Antiplatelet Therapy-3) trial were included. Aspirin and clopidogrel monotherapy were compared beyond 30 days and up to 1 year in the prespecified subgroups stratified by HBR or non-HBR and STEMI or NSTE-ACS. The coprimary cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke; the coprimary bleeding endpoint was major bleeding (Bleeding Academic Research Consortium type 3 or 5).
Results:
Among 4,353 patients, 1,711 had HBR and 2,457 had STEMI. Throughout the 335-day follow-up period, the crude HRs for aspirin compared with clopidogrel were not statistically significant for cardiovascular endpoints in both the HBR or non-HBR (HR: 0.89 [95% CI: 0.61-1.30] and HR: 1.08 [95% CI: 0.61-1.90]; P for interaction = 0.59) and STEMI or NSTE-ACS (HR: 1.01 [95% CI: 0.68-1.50] and HR: 0.81 [95% CI: 0.48-1.37]; P for interaction = 0.51) subgroups. Similarly, the HRs for bleeding endpoints were not significant in both the HBR or non-HBR (HR: 0.73 [95% CI: 0.40-1.33] and HR: 0.71 [95% CI: 0.23-2.24]; P for interaction = 0.97) and STEMI or NSTE-ACS (HR: 0.96 [95% CI: 0.46-2.01] and HR: 0.53 [95% CI: 0.24-1.17]; P for interaction = 0.28) subgroups.
Conclusions:
In patients with ACS, aspirin and clopidogrel demonstrated comparable effects on both cardiovascular and bleeding outcomes beyond 1 month and up to 1 year after percutaneous coronary intervention, irrespective of HBR or non-HBR and STEMI or NSTE-ACS. (Short and Optimal Duration of Dual Antiplatelet Therapy-3 Study [STOPDAPT-3]; NCT04609111).
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins