# Clopidogrel versus aspirine als langetermijnmonotherapie na PCI: bevestiging

*geplaatst 2024-01-02 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2023.10.013 · https://hartvaat.nl/2024/01/02/clopidogrel-versus-aspirine-als-langetermijnmonotherapie-na-pci-bevestiging/*

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.

## English: Clopidogrel vs Aspirin Monotherapy Beyond 1 Year After Percutaneous Coronary Intervention.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2023.10.013. Bijgewerkt 2026-07-03T13:29:47Z. 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.