Which antiplatelet is better after stents? A meta-analysis of aspirin vs clopidogrel in the maintenance phase.

Coronary artery disease (CAD) remains a leading cause of global mortality and disability, with percutaneous coronary intervention (PCI) being a prevalent treatment. Dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) is a standard approach post-PCI. However, the optimal choice between aspirin and clopidogrel during SAPT, especially for high risk of bleeding patients, remains debated. This systematic review and meta-analysis aimed to assess the effectiveness and safety of aspirin versus clopidogrel monotherapy in CAD patients after PCI. A comprehensive literature search identified 11 studies (seven RCTs and four cohorts) involving 26,324 patients, with 11,435 on clopidogrel and 14,889 on aspirin. Our analysis found that clopidogrel was significantly associated with no significant difference regarding major bleeding compared to aspirin; however, after sensitivity analysis, clopidogrel monotherapy resulted in statistically significant 36% and 25% reduction, respectively. The findings suggest that clopidogrel monotherapy is not inferior to aspirin monotherapy, warranting its consideration in long-term SAPT post-PCI.