This presentation, delivered during EuroPCR 2026, analyzed the clinical outcomes of clopidogrel monotherapy versus aspirin in patients who remained event-free for 12 months after percutaneous coronary intervention (PCI).
Historically, aspirin has been the cornerstone of long-term antiplatelet therapy. However, emerging evidence suggests that P2Y12 inhibitors such as clopidogrel may provide greater efficacy and better gastrointestinal tolerability. The aim of the study was to compare the efficacy and safety of both drugs in a real-world setting, with a particular focus on challenging subgroups, including patients with high bleeding risk (HBR) and/or complex PCI.
A prospective observational cohort study was conducted at Fuwai Hospital (China), including 5,664 patients who had completed standard 12-month dual antiplatelet therapy (DAPT) without adverse events. The population was divided into two monotherapy groups: clopidogrel (n=1,974) and aspirin (n=3,690).
The primary endpoint was the incidence of net adverse clinical events (NACE) at 36 months, defined as the composite of all-cause death, myocardial infarction, stroke, or BARC type 2, 3, or 5 bleeding.
The results demonstrated a significant reduction in NACE in favor of clopidogrel, with a significantly lower incidence compared with aspirin (2.5% vs 4.7%; HR 0.52; p<0.001). In addition, the risk of major cardiac or cerebral events — including death, myocardial infarction, or stroke — was also substantially lower with clopidogrel (1.3% vs 3.0%; HR 0.43; p<0.001).
Clopidogrel also showed a trend toward lower rates of clinically relevant bleeding (BARC 2, 3, or 5), although this finding did not reach strict statistical significance (1.2% vs 1.9%; p=0.077). The net clinical benefit of clopidogrel remained consistent regardless of bleeding risk (HBR) or PCI complexity.
Conclusion: Clopidogrel reduced cardiovascular events versus aspirin as post-PCI monotherapy
In patients who remain event-free after completing the standard DAPT period, clopidogrel appears to provide better long-term clinical protection than aspirin and could therefore be considered a preferred maintenance strategy, even in high bleeding risk or complex PCI settings.
Original Title: Net Clinical Outcomes of Clopidogrel vs Aspirin Monotherapy after Coronary Stenting by Bleeding Risk and PCI Complexity.
Reference: Presentado por Hao-Yu Wang en EuroPCR 2026.
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