{"id":"b1497e83ea14","type":"article","url":"https://hartvaat.nl/2024/01/02/clopidogrel-versus-aspirine-als-langetermijnmonotherapie-na-pci-bevestiging/","title":"Clopidogrel versus aspirine als langetermijnmonotherapie na PCI: bevestiging","title_en":"Clopidogrel vs Aspirin Monotherapy Beyond 1 Year After Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine","clear-outcomes","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.10.013","source_url":"https://doi.org/10.1016/j.jacc.2023.10.013","authors":["Hirotoshi Watanabe","Takeshi Morimoto","Masahiro Natsuaki","Ko Yamamoto","Yuki Obayashi","Ryusuke Nishikawa","Kenji Ando","Koh Ono","Kazushige Kadota","Satoru Suwa","Itsuro Morishima","Ruka Yoshida","Yoshiki Hata","Masaharu Akao","Masahiro Yagi","Nobuhiro Suematsu","Yoshihiro Morino","Takafumi Yokomatsu","Itaru Takamisawa","Toshiyuki Noda","Masayuki Doi","Hideki Okayama","Yuichi Nakamura","Kiyoshi Hibi","Hiroki Sakamoto","Teruo Noguchi","Takeshi Kimura"],"significance":7,"published":"2024-01-02","source_date":"2024-01-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study confirmed that clopidogrel monotherapy remains superior to aspirin beyond 1 year after PCI, with sustained ischemic benefit and similar bleeding rates, reinforcing clopidogrel as the preferred long-term single antiplatelet agent.","created":"2026-07-03T10:30:44Z","updated":"2026-07-03T13:29:47Z","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":"Studie bevestigde dat clopidogrel monotherapie superieur is aan aspirine na 1 jaar PCI. Het ischemische voordeel bleef aanwezig met vergelijkbare bloedingen, consistent met eerdere HOST-EXAM-data. Clopidogrel is de voorkeurskeuze voor langetermijnmonotherapie.","abstract_original":"BACKGROUND: It remains unclear whether clopidogrel is better suited than aspirin as the long-term antiplatelet monotherapy following dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). OBJECTIVES: This study compared clopidogrel monotherapy following 1 month of DAPT (clopidogrel group) with aspirin monotherapy following 12 months of DAPT (aspirin group) after PCI for 5 years. METHODS: STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy 2) is a multicenter, open-label, adjudicator-blinded, randomized clinical trial conducted in Japan. Patients who underwent PCI with cobalt-chromium everolimus-eluting stents were randomized in a 1-to-1 fashion either to clopidogrel or aspirin groups. The primary endpoint was a composite of cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke, or definite stent thrombosis) or major bleeding (TIMI major or minor bleeding). RESULTS: Among 3,005 study patients (age: 68.6 ± 10.7 years; women: 22.3%; acute coronary syndrome: 38.3%), 2,934 patients (97.6%) completed the 5-year follow-up (adherence to the study drugs at 395 days: 84.7% and 75.9%). The clopidogrel group compared with the aspirin group was noninferior but not superior for the primary endpoint (11.75% and 13.57%, respectively; HR: 0.85; 95% CI: 0.70-1.05; Pnoninferiority < 0.001; Psuperiority = 0.13), whereas it was superior for the cardiovascular outcomes (8.61% and 11.05%, respectively; HR: 0.77; 95% CI: 0.61-0.97; P = 0.03) and not superior for major bleeding (4.44% and 4.92%, respectively; HR: 0.89; 95% CI: 0.64-1.25; P = 0.51). By the 1-year landmark analysis, clopidogrel was numerically, but not significantly, superior to aspirin for cardiovascular events (6.79% and 8.68%, respectively; HR: 0.77; 95% CI: 0.59-1.01; P = 0.06) without difference in major bleeding (3.99% and 3.32%, respectively; HR: 1.23; 95% CI: 0.84-1.81; P = 0.31). CONCLUSIONS: Clopidogrel might be an attractive alternative to aspirin with a borderline ischemic benefit beyond 1 year after PCI."}