Will the Lifelong Drug After Stent Change?... 'Clopidogrel' More Effective Than Aspirin

Reduced Risk of Clinical Events, Thrombosis, and Bleeding Over 10 Years in 5,438 Patients
Published in The Lancet, Drawing Attention to Potential Changes in Treatment Guidelines

A 10-year follow-up clinical study has found that clopidogrel is superior to aspirin as a single antiplatelet maintenance therapy following stent implantation. This result is drawing attention to the possibility of shifting the long-standing “lifelong aspirin” treatment paradigm.

From the left, Professor Hyo Soo Kim at Seoul National University Hospital Biomedical Research Institute, Professors Kyung Woo Park, Jihoon Kang, and Hanmo Yang from the Department of Cardiology, and Professor Sung Jun Park from the Department of Cardiology at Boramae Medical Center. Seoul National University Hospital

Seoul National University Hospital announced on May 7 that the research team led by Professor Hyo-Soo Kim of the Department of Biomedical Sciences, along with Professors Jihoon Kang, Hanmo Yang, and Kyungwoo Park of the Department of Cardiology at Seoul National University Hospital, and Professor Seongjun Park of the Department of Cardiology at Boramae Medical Center, published the 10-year follow-up results of the HOST-EXAM study targeting 5,438 patients who underwent stent implantation, in the latest issue of the international journal "The Lancet."

Patients with ischemic heart disease typically take antiplatelet agents for an extended period after undergoing coronary stent implantation to prevent recurrence of thrombosis. Generally, two agents are used concurrently immediately after the procedure, after which a single antiplatelet agent is maintained for life. Current international clinical guidelines recommend aspirin as the standard long-term maintenance therapy.

The research team conducted the study from 2014 to 2018 at 37 medical institutions nationwide, focusing on patients who remained stable without recurrence for 6 to 18 months after stent implantation. The patients were randomly assigned to either an aspirin group or a clopidogrel group, and the investigators tracked their clinical outcomes over 10 years.

The analysis showed that the primary endpoint, the overall clinical event rate, was 28.5% in the aspirin group and 25.4% in the clopidogrel group. The clopidogrel group had a 14% lower risk of all clinical events, including death, myocardial infarction, stroke, rehospitalization for acute coronary syndrome, and major bleeding.

The difference was even more pronounced in the per-protocol group (4,179 patients) who continued the assigned medication without interruption. In this group, the clopidogrel group reduced the risk of all clinical events by 24%, and also showed a 31% reduction in the risk of recurrent thrombosis and a 27% reduction in bleeding risk. There was no difference in overall mortality between the two groups. The research team noted that the discontinuation rate due to gastrointestinal discomfort or minor bleeding was higher in the aspirin group.

Professor Kim, who led the study, stated, "This is the first large-scale, randomized trial to compare lifelong single antiplatelet therapy in stent patients for 10 years. Given that clopidogrel reduces both thrombotic and bleeding risks, these results may lead to changes in global clinical guidelines in the future."

This content was produced with the assistance of AI translation services.