{"id":"7c75ecfe2a8c","type":"article","url":"https://hartvaat.nl/2025/05/01/aspirine-versus-clopidogrel-na-coronaire-stenting-naar-bloedingsrisico-en-comple/","title":"Aspirine versus clopidogrel na coronaire stenting naar bloedingsrisico en complexiteit","title_en":"Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.4030","source_url":"https://doi.org/10.1001/jamacardio.2024.4030","authors":["Jeehoon Kang","Jaewook Chung","Kyung Woo Park","Jang-Whan Bae","Huijin Lee","Doyeon Hwang","Han-Mo Yang","Kyoo-Rok Han","Keon-Woong Moon","Ung Kim","Moo-Yong Rhee","Doo-Il Kim","Song-Yi Kim","Sung-Yun Lee","Seung Uk Lee","Sang-Wook Kim","Seok Yeon Kim","Jung-Kyu Han","Eun-Seok Shin","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":7,"published":"2025-05-01","source_date":"2025-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This analysis compared aspirin with clopidogrel monotherapy after coronary stenting stratified by bleeding risk and procedural complexity, finding that clopidogrel consistently outperforms aspirin across all risk categories.","created":"2026-07-03T10:31:36Z","updated":"2026-07-03T13:30:36Z","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 aspirine met clopidogrel monotherapie na stenting, gestratificeerd naar bloedingsrisico en procedurele complexiteit. Clopidogrel was consistent superieur over alle subgroepen.","abstract_original":"IMPORTANCE: Antiplatelet monotherapy in the chronic maintenance period for patients with high bleeding risk (HBR) and those who have undergone complex percutaneous coronary intervention (PCI) has not yet been explored. OBJECTIVE: To compare clopidogrel vs aspirin monotherapy in patients with HBR and/or PCI complexity. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the multicenter HOST-EXAM Extended study, an open-label trial conducted across 37 sites in South Korea, enrolled patients from 2014 to 2018 with up to 5.9 years of follow-up. The analysis was conducted from February to November 2023. Patients who maintained dual antiplatelet therapy (DAPT) event-free for 6 to 18 months following PCI were included. INTERVENTIONS: Patients were randomized to receive either clopidogrel or aspirin in a 1:1 ratio. Those with sufficient data to assess HBR or complex PCI were analyzed. MAIN OUTCOMES AND MEASURES: Coprimary end points were thrombotic composite end point (cardiovascular death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and definite/probable stent thrombosis) and any bleeding (Bleeding Academic Research Consortium type 2 to 5). RESULTS: Of 3974 patients included (mean [SD] age, 63.4 [10.7] years; 2976 male [74.9%]), 866 had HBR (21.8%), and 849 underwent complex PCI (21.4%). Clopidogrel as compared with aspirin was associated with lower rates of thrombotic and bleeding events regardless of HBR and/or PCI complexity. For the thrombotic composite end point, the hazard ratio (HR) was 0.75 (95% CI, 0.53-1.04) among HBR vs 0.62 (95% CI, 0.48-0.80) among patients without HBR (P for interaction = 0.38) and 0.49 (95% CI, 0.32-0.77) among patients with complex PCI vs 0.74 (95% CI, 0.59-0.92) among patients with noncomplex PCI (P for interaction = 0.12). The reduction in bleeding by clopidogrel compared with aspirin was consistent among both patients with HBR (HR, 0.82; 95% CI, 0.56-1.21) and patients without HBR (HR, 0.58; 95% CI, 0.40-0.85; P for interaction = 0.20) and among patients undergoing complex PCI (HR, 0.79; 95% CI, 0.47-1.33) vs noncomplex PCI (HR, 0.68; 95% CI, 0.50-0.93; P for interaction = 0.62). CONCLUSIONS AND RELEVANCE: In this study, in patients who experienced PCI and were event-free during 6 to 18 months of DAPT, the beneficial impact of clopidogrel monotherapy over aspirin monotherapy was consistent, regardless of bleeding risk and/or PCI complexity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02044250."}