Clopidogrel monotherapy after dual antiplatelet therapy (DAPT) was associated with reduced mortality, MI, stroke, and other events in patients receiving PCI compared against aspirin monotherapy (ASA).
This information was provided by the Korean HOST-EXAM study, presented at ACC 2021 scientific sessions, and simultaneously published in the Lancet.
Researchers followed patients for 2 years and observed consistent results across subgroups, regardless baseline and angiographic characteristics.
Primary end point, a combination of all cause death, MI, stroke, BARC 3 bleeding or higher, at 24 months, occurred in 5.7% of patients randomized to clopidogrel vs 7.7% of patients randomized to ASA (HR 0.73; IC 95% 0.59 a 0.90).
According to authors, the benefits of clopidogrel were observed both in thrombotic and bleeding terms. However, a longer followup in other populations is necessary (the whole cohort was Korean) to be able to reach more definitive conclusions.
Guidelines on both sides of the Atlantic recommend ASA at long term after coronary PCI, but these study outcomes challenge ASA.
Read also: ACC 2021 | RAPID-TnT: Usefulness of High-Sensitivity Ultra-Fast Troponin T.
The HOST-EXAM randomized 5530 patients from 37 centers in Korea. All patients were free of events (thrombotic or bleeding) were within 6 to 18 months after coronary PCI and had completed the indicated DAPT period.
At the moment of intervention, over half of patients presented stable angina, 19.4% non-STEMI and 17.2% STEMI.
These new and provocative data raise our expectations for longer followup and similar results across different populations.
HOST-EXAMOriginal Title: Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial.
Reference: Bon-Kwon Koo et al. Presentado en el congreso de la ACC 2021 y publicado simultáneamente en Lancet. https://doi.org/10.1016/S0140-6736(21)01063-1.
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