Clopidogrel monotherapy okay beyond one year of DAPT after PCI

A recent study from the STOPDAPT-2 trial explored the efficacy of clopidogrel as a long-term antiplatelet monotherapy following dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). The findings were published in the Journal of the American College of Cardiology.

The objective of the study was to compare clopidogrel monotherapy following one month of DAPT with aspirin monotherapy after 12 months of DAPT in patients who underwent PCI with cobalt-chromium everolimus-eluting stents. This study spanned over a 5-year period and the outcomes suggest that clopidogrel might present a compelling alternative to aspirin in the post-PCI landscape.

This multicenter, open-label, randomized clinical trial included a total of 3,005 patients, with 2,934 completing the full 5-year follow-up. The clopidogrel group demonstrated noninferiority but not superiority in comparison to the aspirin group. The primary endpoint of the research was a composite of cardiovascular outcomes or major bleeding.

Clopidogrel showed superiority for cardiovascular outcomes, reporting 8.61% when compared to aspirin's 11.05%. The 1-year landmark analysis exhibited the numerical superiority of clopidogrel for cardiovascular events, though not statistically significant. Major bleeding rates remained comparable between clopidogrel and aspirin.

The study suggests that clopidogrel might emerge as an effective alternative to aspirin in long-term antiplatelet therapy post-PCI. Also, clopidogrel demonstrated potential ischemic benefits beyond the first year after PCI. These findings suggest for reconsidering antiplatelet strategies by providing valuable insights for clinicians navigating the complex terrain of post-PCI care. Further research and inputs will be imperative to solidify these observations that can potentially reshape the standard of care in cardiovascular medicine.

Source:

Watanabe, H., Morimoto, T., Natsuaki, M., Yamamoto, K., Obayashi, Y., Nishikawa, R., Ando, K., Ono, K., Kadota, K., Suwa, S., Morishima, I., Yoshida, R., Hata, Y., Akao, M., Yagi, M., Suematsu, N., Morino, Y., Yokomatsu, T., Takamisawa, I., … Kimura, T. (2024). Clopidogrel vs Aspirin Monotherapy Beyond 1 Year After Percutaneous Coronary Intervention. In Journal of the American College of Cardiology (Vol. 83, Issue 1, pp. 17–31). Elsevier BV. https://doi.org/10.1016/j.jacc.2023.10.013