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Clopidogrel monotherapy is associated with higher mortality risk compared to aspirin: a retrospective analysis of
Tieshi Zhu1,2, Yong He3, Yuzhang Bei3
1Department of Medical Affairs, Agricultural Reclamation Central Hospital of Guangdong, Zhanjiang, Guangdong, China.
Insights
Clopidogrel monotherapy was linked to increased risks of death, stroke, and cardiac events compared to aspirin in a community study. This finding contrasts with some previous research, highlighting the need for careful consideration of antiplatelet therapy choices.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Epidemiology
Background:
- Clopidogrel and aspirin are common antiplatelet medications.
- Previous studies suggest clopidogrel may be superior to aspirin in specific patient groups, but its effectiveness in populations with lower clopidogrel resistance is less understood.
Purpose of the Study:
- To compare the risks of mortality, stroke, and cardiac events between patients receiving clopidogrel monotherapy versus aspirin monotherapy.
- To investigate these risks in a general community-based population.
Main Methods:
- Analysis of 1,007 participants from NHANES 1999-2018 on aspirin or clopidogrel monotherapy.
- Utilized Cox proportional hazards regression and Kaplan-Meier survival analyses.
- Conducted sensitivity analyses excluding early deaths (within 6 months).
Main Results:
- Clopidogrel use was associated with significantly higher risks of all-cause mortality (HR 1.31-1.47) and stroke/cardiac mortality (HR 1.47-1.76) compared to aspirin.
- Findings remained consistent across different Cox models and sensitivity analyses.
- Kaplan-Meier curves visually supported increased mortality risks with clopidogrel.
Conclusions:
- In a community-based setting, clopidogrel monotherapy showed higher risks for all-cause mortality, stroke, and cardiac mortality compared to aspirin.
- These results suggest a potential difference in comparative effectiveness between clopidogrel and aspirin monotherapy in the general population.
Background:
Clopidogrel and aspirin are widely used antiplatelet agents. Although clopidogrel resistance is more prevalent in Asian populations, a Korean study suggested that clopidogrel was superior to aspirin in patients who completed standard dual antiplatelet therapy following percutaneous coronary intervention. However, the comparative effectiveness of clopidogrel versus aspirin in populations with lower levels of clopidogrel resistance remains to be further investigated.
Methods:
This study included 1,007 participants from NHANES 1999-2018 who were receiving aspirin or clopidogrel monotherapy. Cox proportional hazards regression and Kaplan-Meier survival analyses were used to compare the risks of mortality between the two groups. Sensitivity analyses were conducted by excluding individuals who died within the first 6 months of follow-up.
Results:
Across all Cox models, clopidogrel use was associated with significantly higher risks of all-cause mortality (Model 1, HR1.47, 95%CI 1.20-1.79, p < .01; Model 2, HR1.25, 95%CI 1.02-1.54, p = .03; Model 3, HR 1.33, 95%CI 1.08-1.64, p = .01; Model 4, HR1.31, 95%CI 1.06-1.63, p = .01), stroke and cardiac mortality (Model 1, HR1.76, 95%CI 1.27-2.43, p < .01; Model 2, HR1.41, 95%CI 1.01-1.97, p = .04; Model 3, HR 1.54, 95%CI 1.10-2.17, p = .01; Model 4, HR1.47, 95%CI 1.03-2.08, p = .03) compared with aspirin. These associations remained consistent in sensitivity analyses. Kaplan-Meier survival curves also indicated higher risks of all-cause mortality, stroke and cardiac mortality in the clopidogrel group relative to the aspirin group.
Conclusion:
In this community-based population, clopidogrel monotherapy was associated with higher risks of all-cause mortality, stroke and cardiac mortality compared with aspirin.
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