Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Cardiology. https://doi.org/10.1001/jamacardio.2024.4030 Dr. Jeehoon Kang et al.
Points
- The HOST-EXAM Extended trial compared clopidogrel versus aspirin monotherapy in reducing thrombotic and bleeding risks during the chronic maintenance period after percutaneous coronary intervention (PCI), particularly in high bleeding risk (HBR) and complex PCI patients.
- Clopidogrel reduced thrombotic events by 25% in HBR patients and 51% in those with complex PCI, outperforming aspirin in both groups.
- Clopidogrel lowered bleeding risks, especially in patients without HBR (hazard ratio 0.58), highlighting its dual protective benefits.
- Regardless of bleeding risk or PCI complexity, clopidogrel consistently showed superior protection against thrombotic and bleeding events compared to aspirin.
- The findings suggest that clopidogrel is preferable over aspirin for chronic maintenance therapy following PCI across different patient risk profiles.
Summary
A post hoc analysis of the HOST-EXAM Extended clinical trial compared the effectiveness of clopidogrel versus aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention (PCI), specifically examining its impact on patients with high bleeding risk (HBR) or complex PCI. The study, which included 3,974 patients with a mean age of 63.4 years (74.9% male), aimed to assess whether clopidogrel provided superior protection against thrombotic and bleeding events in this population. Patients who had been event-free for 6 to 18 months of dual antiplatelet therapy (DAPT) were randomized to receive either clopidogrel or aspirin.
The results showed that clopidogrel was associated with a lower risk of thrombotic and bleeding events than aspirin, regardless of bleeding risk or PCI complexity. In patients with HBR, clopidogrel demonstrated a 25% reduction in the risk of thrombotic events (hazard ratio [HR] 0.75; 95% CI, 0.53-1.04), while those without HBR experienced a more pronounced benefit (HR 0.62; 95% CI, 0.48-0.80). For patients with complex PCI, clopidogrel reduced the risk of thrombotic events by 51% (HR 0.49; 95% CI, 0.32-0.77), compared with 26% among those with noncomplex PCI (HR 0.74; 95% CI, 0.59-0.92). The bleeding risk was also reduced with clopidogrel, particularly in patients without HBR (HR 0.58; 95% CI, 0.40-0.85).
Overall, clopidogrel monotherapy was consistently more effective than aspirin, demonstrating superior efficacy in reducing thrombotic and bleeding risks in patients with various bleeding risks and PCI complexities. These findings suggest that clopidogrel may be a preferable option for chronic maintenance therapy after PCI, regardless of these factors.
Link to the article: https://jamanetwork.com/journals/jamacardiology/article-abstract/2826880
References Kang, J., Chung, J., Park, K. W., Bae, J.-W., Lee, H., Hwang, D., Yang, H.-M., Han, K.-R., Moon, K.-W., Kim, U., Rhee, M.-Y., Kim, D.-I., Kim, S.-Y., Lee, S.-Y., Lee, S. U., Kim, S.-W., Kim, S. Y., Han, J.-K., Shin, E.-S., … Kim, H.-S. (2024). Long-term aspirin vs clopidogrel after coronary stenting by bleeding risk and procedural complexity. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2024.4030
