Clopidogrel Versus Aspirin Monotherapy Following Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

Authors

Bryan E-Xin Tan, Rochester Regional HealthFollow
Pui Yen Wong, Sungai Buloh Hospital
Bipul Baibhav, Rochester Regional HealthFollow
Samarthkumar Thakkar, Rochester Regional HealthFollow
Abdullah Zoheb Azhar, Rochester Regional HealthFollow
Mohan Rao, Rochester Regional HealthFollow
Jim W. Cheung, Weill Cornell Medicine

Department

Internal Medicine

Document Type

Article

Publication Title

Current Problems in Cardiology

Abstract

BACKGROUND: Current guidelines recommend 6 to 12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) followed by aspirin monotherapy indefinitely. We aimed to assess the efficacy and safety of clopidogrel versus aspirin in the post-PCI population after completing DAPT. METHODS: We systematically searched five electronic databases to identify studies comparing clopidogrel with aspirin following completion of DAPT after PCI. We pooled outcomes for major adverse cardiac events (MACE), cardiac death, all-cause death, major bleeding, myocardial infarction (MI), and stroke. RESULTS: We included five studies with 13,850 patients, of whom 5601 (40.4%) received clopidogrel. Mean follow-up was 12-36 months. All patients received drug-eluting stents. Duration of DAPT before antiplatelet monotherapy was 1-18 months. Clopidogrel was associated with reductions in MACE (Risk ratio [RR] 0.78, 95% confidence interval [CI] 0.66-0.92), any stroke (RR 0.51; 95% confidence interval [CI] 0.35-0.76), ischemic stroke (RR 0.55; 95% CI 0.32-0.94), and hemorrhagic stroke (RR 0.24; 95% CI 0.09-0.68) when compared with aspirin. Cardiac death (RR 0.87; 95% CI 0.53-1.41), all-cause death (RR 1.06; 95% CI 0.81-1.39), major bleeding (RR 0.74; 95% CI 0.43-1.29), MI (RR 1.01; 95% CI 0.64-1.60), repeat revascularization (RR 0.88; 95% CI 0.71-1.09), target vessel revascularization (RR 0.76; 95% CI 0.52-1.13), and stent thrombosis (RR 0.96; 95% CI 0.35-2.59) were not significantly different among groups. CONCLUSION: Compared with aspirin, clopidogrel was associated with reductions in MACE and stroke (ischemic and hemorrhagic) following DAPT completion after PCI. There were no significant differences in mortality, major bleeding, MI, and repeat revascularization between groups.

First Page

101174

DOI

10.1016/j.cpcardiol.2022.101174

Volume

48

Issue

8

Publication Date

8-2023

Comments

Record updated with published article citation 2023-06-22 LB.

Published online ahead of print 2022-03-24.

PubMed ID

35341798

Recommended Citation

Tan, B. E., Wong, P. Y., Baibhav, B., Thakkar, S., Azhar, A. Z., Rao, M., & Cheung, J. W. (2023). Clopidogrel Versus Aspirin Monotherapy Following Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. Current Problems in Cardiology, 48 (8), 101174. https://doi.org/10.1016/j.cpcardiol.2022.101174