Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity
Authors' conclusion
In this study, in patients who experienced PCI and were event-free during 6 to 18 months of DAPT, the beneficial impact of clopidogrel monotherapy over aspirin monotherapy was consistent, regardless of bleeding risk and/or PCI complexity.
Study context
- Population
- Patients event-free on dual antiplatelet therapy (DAPT) for 6 to 18 months after percutaneous coronary intervention (PCI), with data to assess high bleeding risk (HBR) or complex PCI866 HBR
- Participants
- 3,974 participants
- Comparison
- Clopidogrel vs aspirin monotherapy, by HBR and PCI complexity
- Primary endpoint
- Coprimary: thrombotic composite (CV death, nonfatal MI, stroke, readmission for ACS, definite/probable stent thrombosis) and any bleeding (BARC type 2 to 5)
- Follow-up
- Up to 5.9 years
Methodological detailspost hoc analysis, open-label, multicentre, 37 sites in South Korea, Enrolment 2014 to 2018; analysis February to November 2023
- Post hoc analysis
- Open-label
- Multicentre
- 37 sites in South Korea
- Enrolment 2014 to 2018; analysis February to November 2023
Primary result
As reported in the abstract
Thrombotic composite end point, by HBR and PCI complexity (subgroups)
Clopidogrel vs AspirinHazard ratio (95% CI)
HBR
0.75(0.53–1.04)
Without HBR
0.62(0.48–0.80)
Complex PCI
0.49(0.32–0.77)
Noncomplex PCI
0.74(0.59–0.92)
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Any bleeding (BARC 2 to 5), by HBR and PCI complexity (coprimary)Clopidogrel vs Aspirin · HBR | 0.82 (0.56–1.21) | |
| Any bleeding (BARC 2 to 5), by HBR and PCI complexity (coprimary)Clopidogrel vs Aspirin · without HBR | 0.58 (0.40–0.85) | |
| Any bleeding (BARC 2 to 5), by HBR and PCI complexity (coprimary)Clopidogrel vs Aspirin · complex PCI | 0.79 (0.47–1.33) | |
| Any bleeding (BARC 2 to 5), by HBR and PCI complexity (coprimary)Clopidogrel vs Aspirin · noncomplex PCI | 0.68 (0.50–0.93) | |
| 0.512Hazard ratio (log scale) |
- Any bleeding (BARC 2 to 5), by HBR and PCI complexity (coprimary): HBR interaction P = 0.20
- Any bleeding (BARC 2 to 5), by HBR and PCI complexity (coprimary): PCI complexity interaction P = 0.62
Original publication
Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity. JAMA Cardiol. Published 1 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it