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Korean researchers have demonstrated the superiority of clopidogrel over aspirin as a treatment to prevent recurrent coronary heart attacks in patients with coronary artery disease.
Samsung Medical Center (SMC) said Monday that a research team led by Professors Hahn Joo-yong, Song Young-bin, and Choi Ki-hong of the hospital’s Department of Cardiovascular Internal Medicine and Professor Park Yong-hwan of the Department of the Cardiovascular Internal Medicine at Samsung Changwon Hospital has published a study showing that clopidogrel is more effective than aspirin in preventing recurrent coronary events in patients with coronary artery disease who have undergone percutaneous coronary intervention (PCI).
Korean researchers are in the spotlight for a study showing that clopidogrel is more effective than aspirin in preventing recurrent heart attacks in patients with coronary artery disease. From left, Professors Hahn Joo-yong, Song Young-bin, Choi Ki-hong, and Park Yong-hwan (Courtesy of SMC)
Korean researchers are in the spotlight for a study showing that clopidogrel is more effective than aspirin in preventing recurrent heart attacks in patients with coronary artery disease. From left, Professors Hahn Joo-yong, Song Young-bin, Choi Ki-hong, and Park Yong-hwan (Courtesy of SMC)
Current U.S. treatment guidelines recommend Dual Antiplatelet Therapy (DAPT), a combination of aspirin and a P2Y12 inhibitor, including clopidogrel, for six months to one year after PCI. Afterward, patients are advised to continue aspirin monotherapy indefinitely. Aspirin and clopidogrel both work by inhibiting the clotting action of platelets.
The study involved 5,506 patients who underwent PCI procedures at 26 medical institutions in Korea between August 2020 and July 2023.
The patients had a history of myocardial infarction, diabetes, and complex coronary lesions, which put them at high risk for future ischemic events, such as myocardial infarction.
The researchers divided the patients who completed dual antiplatelet therapy into two groups—2,752 on clopidogrel and 2,754 on aspirin—and followed them for a median of more than two years.
The results showed that patients taking clopidogrel had a 29 percent lower risk of the study's primary composite endpoint of overall death, myocardial infarction, and stroke than those taking aspirin.
With clopidogrel, the risk of death was reduced by 29 percent and myocardial infarction by 46 percent, respectively, while bleeding rates were not significantly different between the clopidogrel and aspirin groups.
This finding challenges the common belief that increased antiplatelet efficacy comes with a higher bleeding risk.
“Clopidogrel reduced ischemic events compared to aspirin without increasing the risk of bleeding—an important consideration for clinical practice,” the researchers said.
“Clopidogrel was superior to aspirin as lifelong maintenance therapy after a standard duration of dual antiplatelet therapy,” Professor Han said. “Based on this, we hope that future guidelines will recognize clopidogrel monotherapy as at least equivalent to aspirin monotherapy and preferably recommend it for patients at high risk of recurrent ischemic events.”
The findings were published in the latest issue of the international medical journal The Lancet and were recognized as a Late-Breaking Clinical Trial at the American College of Cardiology (ACC) Annual Scientific Sessions in Chicago, the U.S., on March 30.
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Kim Jung-hyun kjh25@docdocdoc.co.kr
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