Related Experiment Video
Updated: May 29, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Clopidogrel Monotherapy in Patients With Chronic Coronary Syndrome Following Coronary Artery Bypass Grafting: A
Onyou Kim1,2, Junwoo Seo1,3, Seung Su Min4
1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
For patients with chronic coronary syndrome after bypass surgery, clopidogrel monotherapy showed similar effectiveness to dual antiplatelet therapy but with significantly less bleeding risk. This suggests clopidogrel may be a safer option for secondary prevention.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- The optimal antiplatelet strategy for secondary prevention in patients with chronic coronary syndrome (CCS) after coronary artery bypass grafting (CABG) is debated.
- Long-term clinical outcomes of different antiplatelet strategies post-CABG require further investigation.
Purpose of the Study:
- To compare long-term clinical outcomes of dual antiplatelet therapy (DAPT), aspirin monotherapy, and clopidogrel monotherapy after CABG in patients with CCS.
- To evaluate the efficacy and safety of different antiplatelet regimens for secondary prevention.
Main Methods:
- A retrospective cohort study involving 29,898 patients with CCS who underwent CABG from 2010-2020.
- Patients were stratified by antiplatelet therapy at discharge: DAPT, aspirin monotherapy, or clopidogrel monotherapy.
- Primary endpoints included major adverse cardiac and cerebrovascular events (MACCE) and major bleeding over 10 years.
Main Results:
- Aspirin monotherapy was associated with a higher risk of MACCE compared to DAPT (adjusted HR, 1.16; 95% CI, 1.06-1.27).
- No significant difference in MACCE was found between DAPT and clopidogrel monotherapy (adjusted HR, 1.05; 95% CI, 0.85-1.29).
- Clopidogrel monotherapy showed a significantly lower risk of major bleeding compared to DAPT (adjusted HR, 0.36; 95% CI, 0.14-0.98).
Conclusions:
- Clopidogrel monotherapy offers comparable ischemic event rates and a reduced risk of major bleeding compared to DAPT in CCS patients post-CABG.
- Clopidogrel monotherapy presents a potentially favorable balance of efficacy and safety for secondary prevention in this patient group.
Background And Objectives:
The optimal antiplatelet strategy for secondary prevention in patients with chronic coronary syndrome (CCS) after coronary artery bypass grafting (CABG) remains controversial. We compared long-term clinical outcomes according to the antiplatelet strategy after CABG.
Methods:
A total of 29,898 patients with CCS who underwent CABG were identified from the Korean National Health Insurance Service database between January 2010 and December 2020. After applying exclusion criteria, the population was stratified based on antiplatelet use at discharge: dual antiplatelet therapy (DAPT, n=7,304), aspirin monotherapy (n=1,524), or clopidogrel monotherapy (n=218). The primary efficacy endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, spontaneous myocardial infarction, and stroke up to 10 years. The primary safety endpoint was major bleeding requiring transfusion.
Results:
The risk of MACCE was higher in the aspirin monotherapy group compared with DAPT at 10 years (39.9% vs. 47.7%, adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.06-1.27). No significant difference was observed between DAPT and clopidogrel monotherapy (39.9% vs. 40.4%, adjusted HR, 1.05; 95% CI, 0.85-1.29). The risk of major bleeding requiring transfusion was lower with clopidogrel monotherapy than with DAPT (2.1% vs. 5.6%, adjusted HR, 0.36; 95% CI, 0.14-0.98), while rates were similar between DAPT and aspirin monotherapy (5.6% vs. 6.5%, adjusted HR, 1.06; 95% CI, 0.81-1.38).
Conclusions:
In patients with CCS undergoing CABG, clopidogrel monotherapy was associated with comparable ischemic outcomes and a lower risk of major bleeding compared with DAPT. Clopidogrel monotherapy may offer a favorable balance of efficacy and safety as an alternative to DAPT for secondary prevention in this population.
Trial Registration:
ClinicalTrials.gov Identifier: NCT06881901.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care