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For high-risk patients post-PCI, clopidogrel shows better efficacy than aspirin without compromising safety.
Clopidogrel monotherapy substantially reduced the risk of major cardiovascular events compared to aspirin in high-risk people who completed standard dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), according to findings from a large randomized trial in South Korea.
In this multicentre, open-label study involving 5,506 patients across 26 sites, individuals at high risk for recurrent ischemic events — including those with prior myocardial infarction, diabetes requiring medication, or complex coronary lesions — were randomized to get either clopidogrel (75 mg daily) or aspirin (100 mg daily) after finishing their DAPT course. From PCI to randomization, the median time was 17.5 months.
Over a median follow-up of 2.3 years, the composite key endpoint of death from any cause, myocardial infarction, or stroke happened in less no. of people in the clopidogrel group as opposed to the aspirin group. Clopidogrel also showed numerically lower rates of all-cause death, myocardial infarction, and stroke over 3 years. Notably, the risk of bleeding — a critical safety concern — was similar between the two groups, and clopidogrel was not linked to a higher incidence of adverse events (Table 1).
Thus, in high-risk people who have completed DAPT after PCI, clopidogrel monotherapy offers superior protection against major cardiovascular events than aspirin, without escalating bleeding risk.
Lancet
Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial
Ki Hong Choi et al.
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