Department of Internal Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Clin Cardiol. 2024 Sep;47(9):e24326. doi: 10.1002/clc.24326.
This study aimed to evaluate the comparative effectiveness and safety of clopidogrel versus aspirin as monotherapy following adequate dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS).
MEDLINE, Embase, and CENTRAL were searched from database inception to September 1, 2023. Randomized controlled trials (RCTs) and observational studies evaluating the effectiveness or safety of clopidogrel versus aspirin as monotherapy following DAPT in patients with ACS who received a drug-eluting stent were included. Random-effects meta-analyses were conducted to compare risks of major adverse cardiovascular events (MACE) and clinically relevant bleeding.
Of 6242 abstracts identified, three unique studies were included: one RCT and two retrospective cohort studies. Studies included a total of 7081 post-percutaneous coronary intervention ACS patients, 4260 of whom received aspirin monotherapy and 2821 received clopidogrel monotherapy. Studies included variable proportions of patients with ST-elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. From the meta-analysis, clopidogrel was associated with a 28% reduction in the risk of MACE compared with aspirin (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), with no significant difference in clinically relevant bleeding (HR: 0.92; 95% CI: 0.68, 1.24).
Despite the paucity of published evidence on the effectiveness and safety of clopidogrel versus aspirin in patients with ACS post-drug-eluting stent implantation, this meta-analysis suggests that clopidogrel versus aspirin may result in a lower risk of MACE, with a similar risk of major bleeding. The present results are hypothesis-generating and further large RCTs comparing antiplatelet monotherapy options in ACS patients are warranted.
本研究旨在评估在急性冠状动脉综合征（ACS）患者接受充分双联抗血小板治疗（DAPT）后，氯吡格雷与阿司匹林单药治疗的相对有效性和安全性。
从数据库建立到 2023 年 9 月 1 日，检索 MEDLINE、Embase 和 CENTRAL 数据库。纳入评估 ACS 患者接受药物洗脱支架置入后 DAPT 后氯吡格雷与阿司匹林单药治疗有效性或安全性的随机对照试验（RCT）和观察性研究。采用随机效应荟萃分析比较主要不良心血管事件（MACE）和临床相关出血的风险。
在 6242 篇摘要中，有 3 项独特的研究入选：1 项 RCT 和 2 项回顾性队列研究。这些研究共纳入 7081 例经皮冠状动脉介入治疗后的 ACS 患者，其中 4260 例接受阿司匹林单药治疗，2821 例接受氯吡格雷单药治疗。研究纳入了不同比例的 ST 段抬高型心肌梗死（STEMI）、非 ST 段抬高型心肌梗死和不稳定型心绞痛患者。荟萃分析显示，与阿司匹林相比，氯吡格雷可降低 28%的 MACE 风险（风险比 [HR]：0.72；95%置信区间 [CI]：0.54，0.98），但在临床相关出血方面无显著差异（HR：0.92；95% CI：0.68，1.24）。
尽管在接受药物洗脱支架置入术后的 ACS 患者中，氯吡格雷与阿司匹林在有效性和安全性方面的证据有限，但本荟萃分析表明，氯吡格雷与阿司匹林相比可能会降低 MACE 风险，大出血风险相似。目前的结果只是初步结果，需要进一步开展比较 ACS 患者抗血小板单药治疗方案的大型 RCT。
