Single antiplatelet therapy with clopidogrel after percutaneous coronary intervention was associated with lower ischaemic risk than aspirin in a nationwide real-world analysis of patients transitioning to chronic maintenance treatment.
Researchers analysed data from the Korean Health Insurance Review and Assessment Service database to evaluate optimal single antiplatelet therapy during the chronic maintenance period after percutaneous coronary intervention.
The study included 49,227 patients who completed 6 to 24 months of dual antiplatelet therapy before switching to either aspirin monotherapy (20,817) or clopidogrel monotherapy (28,410).
The primary efficacy outcome was a composite of myocardial infarction and ischaemic stroke, while the primary safety outcome combined gastrointestinal bleeding and intracranial haemorrhage.
Propensity score weighting was used to balance baseline characteristics between treatment groups.
Over a median follow up of 3.8 years, the efficacy outcome occurred in 5.7% of patients receiving aspirin and 4.3% of those receiving clopidogrel.
In adjusted analyses, clopidogrel was associated with a lower risk of the efficacy composite compared with aspirin.
This benefit appeared to be driven primarily by a reduction in myocardial infarction risk. Patients receiving clopidogrel experienced fewer myocardial infarctions than those receiving aspirin. Rates of ischaemic stroke were comparable between groups.
The overall safety outcome did not differ significantly between treatment strategies. Gastrointestinal bleeding rates were also similar between groups.
However, clopidogrel was associated with a significantly lower risk of intracranial haemorrhage.
The researchers concluded that, among patients who transitioned from dual antiplatelet therapy to long-term single antiplatelet therapy after percutaneous coronary intervention, clopidogrel monotherapy was associated with lower ischaemic risk, largely due to fewer myocardial infarctions, without an increase in overall bleeding events.
These findings provide real world evidence supporting clopidogrel as a reasonable chronic maintenance single antiplatelet therapy strategy following percutaneous coronary intervention.
Reference
Kwon Y et al. Real-world data for optimal single antiplatelet therapy during the chronic maintenance period after percutaneous coronary intervention: a nationwide study of Korea. Sci Rep. 2026;DOI:10.1038/s41598-026-65621-2.
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