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Aspirin Versus Clopidogrel Beyond 1 Month After PCI in Patients With Oral Anticoagulation
Masahiro Natsuaki1, Hirotoshi Watanabe2, Takeshi Morimoto3
1Department of Cardiovascular Medicine, Saga University, Japan (M.N.).
Insights
Aspirin and clopidogrel showed similar cardiovascular and bleeding outcomes up to one year after percutaneous coronary intervention, regardless of oral anticoagulation (OAC) use. This finding supports both antiplatelet options in OAC patients post-PCI.
Area of Science:
- Cardiology
- Pharmacology
Background:
- No prior studies compared aspirin vs. clopidogrel with oral anticoagulation (OAC) within one year post-percutaneous coronary intervention (PCI).
- Dual therapy with OAC and clopidogrel is often recommended after PCI.
Purpose of the Study:
- To compare the efficacy and safety of aspirin versus clopidogrel in patients undergoing PCI, with or without OAC.
- To evaluate cardiovascular and bleeding events up to one year post-PCI.
Main Methods:
- Subgroup analysis of the STOPDAPT-3 trial, stratifying patients by OAC use.
- Compared 1-month dual antiplatelet therapy followed by aspirin monotherapy versus 1-month prasugrel monotherapy followed by clopidogrel monotherapy.
- Coprimary endpoints: cardiovascular events and Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding events.
Main Results:
- In patients with OAC, cardiovascular event rates were 3.7% for aspirin vs. 3.9% for clopidogrel (HR 0.92).
- In patients without OAC, cardiovascular event rates were 3.7% for aspirin vs. 3.6% for clopidogrel (HR 1.03).
- Bleeding event rates were similar between aspirin and clopidogrel groups, both with and without OAC.
Conclusions:
- Aspirin and clopidogrel demonstrate comparable cardiovascular and bleeding outcomes up to one year post-PCI.
- Treatment choice between aspirin and clopidogrel may not significantly impact outcomes in OAC patients post-PCI.
Background:
There were no previous studies comparing aspirin with clopidogrel on top of oral anticoagulation (OAC) within 1 year after percutaneous coronary intervention when dual therapy with OAC and clopidogrel was recommended.
Methods:
We conducted a subgroup analysis stratified by OAC in the 1-year follow-up of the STOPDAPT-3 trial (Short and Optimal Duration of Dual Antiplatelet Therapy-3), which randomly compared 1-month dual antiplatelet therapy followed by aspirin monotherapy (aspirin group) with 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). This subgroup analysis compared aspirin with clopidogrel in patients with or without OAC by the 30-day landmark analysis. The coprimary end points were the cardiovascular (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke), and bleeding end points (Bleeding Academic Research Consortium 3 or 5).
Results:
In the 30-day landmark analysis (N=5809), there were 788 patients (13.6%) with OAC at discharge. Regardless of OAC, the incidence rates beyond 30 days up to 1 year were similar between the aspirin and clopidogrel groups for cardiovascular end point (OAC: 3.7% versus 3.9%, hazard ratio, 0.92 [95% CI, 0.44-1.93]; no OAC: 3.7% versus 3.6%; hazard ratio, 1.03 [95% CI, 0.77-1.38]; P interaction=0.78) and for bleeding end point (OAC: 3.5% versus 4.2%, hazard ratio, 0.82 [95% CI, 0.39-1.73]; no OAC 1.5% versus 1.4%, hazard ratio, 1.07 [95% CI, 0.66-1.72]; P interaction=0.57).
Conclusions:
Aspirin compared with clopidogrel was associated with similar cardiovascular and bleeding outcomes beyond 30 days and up to 1 year after percutaneous coronary intervention regardless of OAC at discharge.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04609111.
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