The Lancet: Clopidogrel is superior to aspirin in terms of long-term maintenance after stent

Clopidogrel is superior to aspirin.

"These data confirm our working hypothesis that for patients with no adverse events after one year of coronary stent placement, long-term single-agent clopidogrel antiplatelet therapy produces better results than aspirin," said Hyo-Soo Kim, MD

The trial reached its primary endpoint, which is a composite endpoint consisting of death, heart attack, stroke, or major bleeding from any cause within two years of the start of the study.

Ischemic heart disease is a general term for problems caused by insufficient blood supply to the heart, such as heart attack and unstable angina

Blood cells called platelets help blood clot, clopidogrel and aspirin can prevent platelets from clotting

Kim said: "However, it is not yet clear that the best single antiplatelet drug as long-term maintenance treatment after the DAPT course

The trial, called HOST-EXAM (Expanded Antiplatelet Monotherapy), enrolled 5436 patients receiving coronary stents

In addition to the primary endpoint, the researchers also isolated coagulation events (death, heart attack, readmission due to acute coronary syndrome, or stent thrombosis) from all bleeding events and analyzed them as secondary endpoints

"These results confirm that clopidogrel is superior to aspirin in reducing the incidence of clotting events," Kim said

Kim said the results are only applicable to patients who have completed DAPT for 6 to 18 months without any adverse events

He said: "It may be difficult to directly extrapolate our results to patients who have received DAPT for a short period of time, such as patients who have been treated for one to three months

Kim said that in the HOST-EXAM trial, the two-year follow-up time for patients was longer than many previous trials comparing antiplatelet drug regimens to patients receiving coronary stents

Another limitation is that the trial is not blind, which means that both the patient and their doctor know which medication the patient is receiving

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