Tag: Aspirin

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Long-term clopidogrel confers less MACCE, bleeding events vs. aspirin after PCI

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Source:

Wang HY, et al. Featured Clinical Research: Part 2. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2022; Atlanta.

Disclosures:
Wang reports receiving grant and/or research support from the Chinese Academy of Medical Sciences and Peking Union Medical College.


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ATLANTA — Clopidogrel monotherapy after 12 months of event free post-PCI dual antiplatelet therapy was associated with fewer MACCE and bleeding events vs. aspirin monotherapy in high bleeding risk patients, a speaker reported.

Data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions, showed that, at 30 months post-PCI, patients taking the P2Y12 inhibitor clopidogrel, as monotherapy experienced nearly half the risk for all-cause death, MI, definite/probable stent thrombosis, stroke or Bleeding Academic Research Consortium type 2, 3 or 5 bleeding compared with those taking aspirin monotherapy.

Aspirin
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“Trials of early aspirin cessation were not designed to evaluate the effects of these strategies on the endpoints the medications are intended to influence, such as myocardial infarction, stent thrombosis and stroke, and that scarce information is available beyond 1 year,” Hao-Yu Wang, MD, of Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, said during a presentation. “

Prior studies, such as HOST-EXAM, evaluated the use of clopidogrel or aspirin monotherapy after 6 to 18 months of dual antiplatelet therapy following PCI.

As Healio previously reported, the HOST-EXAM primary endpoint of all-cause death, nonfatal MI, ischemic stroke, readmission for ACS or Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater at 24 months was less frequent among patients taking clopidogrel compared with aspirin.

However, Wang said, “Optimal antiplatelet monotherapy during the chronic maintenance period beyond 12 months after PCI with drug-eluting stents in high-risk patients in real-world settings remains unclear.”

Utilizing the Fuwai PCI Registry, researchers identified 5,664 high-risk patients (mean age, 58 years; 76% men; 65% who had PCI for ACS; 17% at high bleeding risk) who were event-free during the initial 12 months of DAPT following PCI and were subsequently switched to either aspirin monotherapy (n = 3,690) or clopidogrel (n = 1,974).

The primary endpoint was a composite of all-cause death, MI, definite/probable stent thrombosis, stroke, or BARC bleeding type 2, 3 or 5, from 12 to 30 months. Secondary endpoints included MACCE, defined as all-cause death, MI, definite/probable stent thrombosis or stroke; and BARC bleeding type 2, 3 or 5.

At 30 months post-PCI, Wang and colleagues observed that 5% of patients taking aspirin monotherapy during the maintenance period experienced the primary composite endpoint compared with 2.5% of the clopidogrel cohort (HR = 0.557; 95% CI, 0.397-0.781; log-rank P = .001).

Over the same period, 3.1% of patients taking aspirin monotherapy experienced the secondary composite endpoint of MACCE compared with 1% of those taking clopidogrel (HR = 0.442; 95% CI, 0.275-0.71; log-rank P = .001).

BARC bleeding type 2, 3 or 5 occurred in 2.1% of the aspirin group at 30 months compared with 1.5% of the clopidogrel arm (HR = 0.732; 95% CI, 0.454-1.181; log-rank P = .199).

Multivariable adjustment did not change the results, and the results did not vary according to prespecified subgroups.

“In this real-world study, clopidogrel monotherapy has effects on all-cause and cardiovascular mortality, as well as stroke, compared with aspirin monotherapy,” Wang said during the presentation. “Therefore, this strategy might be an effective alternative to aspirin for secondary prevention of cardiovascular disease.”


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Society for Cardiovascular Angiography and Interventions

Society for Cardiovascular Angiography and Interventions

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Clopidogrel monotherapy linked with reduced risk of net adverse clinical events, study finds

Clopidogrel monotherapy linked with reduced risk of net adverse clinical events, study finds

Results from a real-world study investigating safety and effectiveness of clopidogrel versus aspirin monotherapy beyond 12 months after PCI in high-risk patients during the chronic maintenance period. This study found that clopidogrel monotherapy was associated with reduced risk of net adverse clinical events (NACE; all-cause death, MI, stent thrombosis, stroke, or BARC type 2, 3, or 5 bleeding) and MACCE (death, MI, stent thrombosis, stroke), and a numerical decrease in major or clinically relevant nonmajor bleeding (BARC type 2, 3, or 5 bleeding), compared with aspirin monotherapy. The findings were presented today as late-breaking clinical research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2022 Scientific Sessions.

P2Y12 inhibitor monotherapy reduces bleeding risk without increasing the risk of ischemic events compared with dual antiplatelet therapy (DAPT), especially in the first 12 months following percutaneous coronary intervention (PCI). Recent research showed that among patients who were event free for six to 18 months post-PCI and successfully received the intended duration of DAPT, clopidogrel monotherapy was superior compared with aspirin monotherapy in terms of NACE. However, optimal antiplatelet monotherapy during the chronic maintenance period beyond 12 months after PCI with drug-eluting stents in high-risk patients in real-world settings is previously unknown.

In total, 8,377 consecutive patients at high risk for both bleeding and thrombosis were identified from the prospective Fuwai PCI Registry if they satisfied one clinical and one angiographic criterion. Patients who received antiplatelet (aspirin or clopidogrel) monotherapy longer than 12 months and were free from ischemic and bleeding events at 12-month post-PCI without extended duration of DAPT were included. The primary endpoint was net adverse clinical events (NACE) from 12 to 30 months. The key secondary endpoints were major adverse cardiac or cerebral events (MACCE) and major or clinically relevant nonmajor bleeding (BARC type 2, 3 or 5).

“These findings show for the first time clopidogrel monotherapy is associated with reduced risk of long-term NACE and MACCE,” said Hao-Yu Wang, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. “Our results may have important practical implications for determining the optimal treatment for patients requiring a single antiplatelet drug, either aspirin or clopidogrel, for secondary prevention of ischemic events in high-risk PCI population.”

Of 7,392 high-risk patients that were event-free after the first year and adherent to DAPT, 5,664 patients who received antiplatelet monotherapy (clopidogrel monotherapy: n=1,974 and aspirin monotherapy: n=3690) were included in the present analysis. Researchers found that between 12 and 30 months, the net adverse clinical events were lower with clopidogrel monotherapy compared to aspirin monotherapy (Kaplan-Meier estimate: 2.5% vs. 5.0%; adjusted HR:0.566, 95% CI: 0.403-0.795). Clopidogrel monotherapy was associated with lower risk for MACCE (Kaplan-Meier estimate: 1.0% vs. 3.1%, log-rank p = 0.001 ), as well as lower incidence rates of all-cause death, MI, and stroke. The difference in risk between the groups was statistically similar for major or clinically relevant nonmajor bleeding (Kaplan-Meier estimate: 1.5% vs. 2.1%, log-rank p = 0.199).

Researchers recommended that their findings should be further investigated through a randomized clinical trial.

Source:

Society for Cardiovascular Angiography and Interventions