Almaadawy Omar, Elnady Mohamed, Elbenawi Hossam, Mohamed Ahmed Almahdy, Elshimy Abdelrahman, Sarhan Menna, Hassan Abdul Rhman, Moheyeldin Eman, Mohamed Alshaimaa G, Ali Nada, Eltony Muhammad, Elmansoury Abdalla, Georges Claudia, Elsalmouny Youmna, Al-Azizi Karim
Department of Internal Medicine, MedStar Health, Baltimore, MD, 21218, USA.
Faculty of Medicine, Kafr El Sheikh University, Kafr El Sheikh, Egypt.
Naunyn Schmiedebergs Arch Pharmacol. 2025 Sep 18. doi: 10.1007/s00210-025-04386-3.
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.
冠状动脉疾病（CAD）仍然是全球死亡和残疾的主要原因，经皮冠状动脉介入治疗（PCI）是一种普遍的治疗方法。PCI术后采用双联抗血小板治疗（DAPT）继以单联抗血小板治疗（SAPT）是一种标准方法。然而，在SAPT期间，尤其是对于出血风险高的患者，阿司匹林和氯吡格雷之间的最佳选择仍存在争议。本系统评价和荟萃分析旨在评估PCI术后CAD患者中阿司匹林与氯吡格雷单药治疗的有效性和安全性。全面的文献检索确定了11项研究（7项随机对照试验和4项队列研究），涉及26324例患者，其中11435例接受氯吡格雷治疗，14889例接受阿司匹林治疗。我们的分析发现，与阿司匹林相比，氯吡格雷与大出血无显著差异；然而，敏感性分析后，氯吡格雷单药治疗分别导致统计学上显著降低36%和25%。研究结果表明，氯吡格雷单药治疗不劣于阿司匹林单药治疗，在PCI术后长期SAPT中值得考虑。
