Watanabe H, Natsuaki M, Morimoto T, et al. Aspirin versus Clopidogrel Monotherapy After Percutaneous Coronary Intervention: 1-Year Follow-up of the STOPDAPT-3 Trial. Eur Heart J. 2024 Aug 31:ehae617. doi: 10.1093/eurheartj/ehae617.
Abstract

BACKGROUND AND AIMS: There was no previous trial comparing aspirin monotherapy with a P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

METHODS: In the STOPDAPT-3, patients with acute coronary syndrome (ACS) or high bleeding risk (HBR) were randomly assigned to either 1-month DAPT with aspirin and prasugrel followed by aspirin monotherapy (aspirin group) or 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). This secondary analysis compared aspirin monotherapy with clopidogrel monotherapy by the 30-day landmark analysis. The co-primary endpoints were the cardiovascular endpoint defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischaemic stroke, and the bleeding endpoint defined as Bleeding Academic Research Consortium 3 or 5.

RESULTS: Of 6002 assigned patients, 5833 patients (aspirin group: N = 2920 and clopidogrel group: N = 2913) were included in the 30-day landmark analysis. Median age was 73 (interquartile range 64-80) years, women 23.4%, ACS 74.6%, and HBR 54.1%. The assigned monotherapy was continued at 1 year in 87.5% and 87.2% in the aspirin and clopidogrel groups, respectively. The incidence rates beyond 30 days and up to 1 year were similar between the aspirin and clopidogrel groups for both cardiovascular endpoint (4.5 and 4.5 per 100 person-year, hazard ratio [HR] 1.00 [95% confidence interval (CI) 0.77-1.30], P = .97), and bleeding endpoint (2.0 and 1.9, HR 1.02 [95% CI 0.69-1.52], P = .92).

CONCLUSIONS: Aspirin monotherapy compared to clopidogrel monotherapy was associated with similar cardiovascular and bleeding outcomes beyond 1 month and up to 1 year after PCI with DES.

Ratings by Clinicians (at least 3 per Specialty)
Specialty Score
Internal Medicine
Cardiology
Hemostasis and Thrombosis
Comments from MORE raters

Cardiology rater

As the authors point out, this technically wasn't an ASA vs clopidogrel trial since the clopidogrel group had a month of prasugrel first, during a more vulnerable period...but still useful information.

Cardiology rater

Important data demonstrating that there is no apparent clinical difference between long-term monotherapy with either aspirin or clopidogrel in patients treated with PCI in this particular study. These data can impact clinical practice and will likely be used in meta-analyses.

Hemostasis and Thrombosis rater

Aspirin monotherapy following 1-month dual antiplatelet therapy is a treatment option after PCI with DES. Confirming information.