{"id":"daa461a1fd96","type":"article","url":"https://hartvaat.nl/2023/10/17/antiplaatjesmonotherapie-na-pci-clopidogrel-versus-aspirine-naar-risicoprofiel/","title":"Antiplaatjesmonotherapie na PCI: clopidogrel versus aspirine naar risicoprofiel","title_en":"Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["aspirine","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.07.031","source_url":"https://doi.org/10.1016/j.jacc.2023.07.031","authors":["Seokhun Yang","Jeehoon Kang","Kyung Woo Park","Seung-Ho Hur","Nam Ho Lee","Doyeon Hwang","Han-Mo Yang","Hyo-Suk Ahn","Kwang Soo Cha","Sang-Ho Jo","Jae Kean Ryu","Il-Woo Suh","Hyun-Hee Choi","Seong-Ill Woo","Jung-Kyu Han","Eun-Seok Shin","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":7,"published":"2023-10-17","source_date":"2023-10-17","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This analysis confirmed clopidogrel's superiority over aspirin as antiplatelet monotherapy after PCI across a range of clinical, ischemic, and bleeding risk profiles, supporting clopidogrel as the default long-term post-PCI antiplatelet agent.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek clopidogrel met aspirine als monotherapie na PCI naar klinisch, ischemisch en bloedingsrisico. Clopidogrel was consistent superieur aan aspirine over alle risicogroepen, wat clopidogrel als standaardmonotherapie na DAPT positioneert.","abstract_original":"BACKGROUND: Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups METHODS: This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization. RESULTS: Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes. CONCLUSIONS: The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)."}