Clopidogrel a feasible alternative to aspirin in post-PCI maintenance phase

The use of clopidogrel for long-term antiplatelet monotherapy during the maintenance phase after percutaneous coronary intervention (PCI) results in reduced adverse cardiovascular and bleeding outcomes compared with aspirin, as shown in the secondary analysis of the HOST-EXAM study.

HOST-EXAM included patients who had completed dual antiplatelet therapy without clinical events for 6–18 months after PCI. These patients were then randomly assigned to receive either clopidogrel 75 mg or aspirin 100 mg, administered once daily in the maintenance setting.

The current analysis covered the 10-year extended follow-up of the HOST-EXAM trial. A composite of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium type ≥3 bleeding was the primary endpoint.

A total of 5,438 patients underwent randomization, with 2,728 allocated to the aspirin group and 2,710 to the clopidogrel group. The median follow-up was 10.5 years after PCI, and the completion rate was 92.8 percent.

During follow-up, the primary composite endpoint occurred less frequently in the clopidogrel group than in the aspirin group (25.4 percent vs 28.5 percent; hazard ratio, 0.86, 95 percent confidence interval, 0.77–0.96; p=0.0050).

When the components of the composite endpoint were analysed individually, clopidogrel was associated with a significantly reduced incidence of the thrombotic (17.3 percent vs 20 percent; p=0.0024) and bleeding endpoints (9.1 percent vs 10.8 percent; p=0.020).

However, all-cause mortality did not significantly differ between the two groups.

The findings underscore the potential of clopidogrel as an alternative to aspirin for long-term antiplatelet monotherapy during the chronic maintenance phase after PCI.