In certain patients, clopidogrel monotherapy better than asp
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In patients who underwent PCI with a drug-eluting stent and took dual antiplatelet therapy for 6 to 18 months, subsequent clopidogrel monotherapy was superior to aspirin monotherapy, according to data from the HOST-EXAM trial.

The researchers randomly assigned 5,438 patients (mean age, 63 years; 75% men) who underwent PCI with a DES and had no ischemic or major bleeding complications after 6 to 18 months of DAPT to receive clopidogrel 75 mg daily monotherapy or aspirin 100 mg daily monotherapy for 24 months. The results were presented at the American College of Cardiology Scientific Session and simultaneously published in The Lancet.

The primary endpoint of all-cause death, nonfatal MI, stroke, readmission for ACS or Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater at 24 months occurred in 5.7% of the clopidogrel group and 7.7% of the aspirin group in the intention-to-treat analysis, Kim said during the press conference.

A per-protocol analysis of the primary endpoint also favored clopidogrel, he said.

He said the thrombotic composite outcome of cardiac death, nonfatal MI, stroke, readmission for ACS or definite or probable stent thrombosis favored the clopidogrel group, as did BARC bleeding type 2 or greater.

According to the researchers, the components of the primary endpoint that favored the clopidogrel group at 24 months were stroke, readmission due to ACS and BARC 3 or greater bleeding.

In addition, minor gastrointestinal complaints were lower in the clopidogrel group. The treatment effect did not vary according to any prespecified subgroups, according to the researchers.

“In patients who were event-free under DAPT for 6 to 18 months after PCI with DES, clopidogrel was better than aspirin monotherapy in reducing the risk of the composite [primary outcome],” researchers said. “Long-term follow-up of this cohort will give us the concrete conclusion on the optimal single agent during the chronic maintenance period after PCI with DES.”

Researchers said, “For a long time, we have been looking for alternatives” because of the bleeding risk posted by aspirin.

“In this U.S., most of us use aspirin as long-term monotherapy after stent placement, so I think [clopidogrel monotherapy] is going to be a fascinating alternative,” she said. “We are going to have to see how widely applied these results are.”

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01063-1/fulltext
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