After PCI and the requisite 6-12 months of DAPT, is it better to continue aspirin or clopidogrel monotherapy?
Working with Dr. McDaniel is certainly making me think about which of these options is best for my stable patients. I enjoyed reading the HOST-EXAM study (attached) and found the results compelling with respect to utilizing clopidogrel monotherapy after DAPT. The study was done in South Korea, but otherwise the patient population reflects our less sick CAD patients reasonably well, including the use of later generation DESs and well-controlled lipids. I’m not sure that one good RCT is enough to be practice-changing for me, and I think the question of aspirin’s protection against cancer remains, but I will be watching this space to help me figure out which choice is best for which patient.
Figure 3. Primary efficacy endpoint in selected subgroups
Koo BK, Kang J, Park KW, et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet (London, England). 2021;397(10293):2487-2496. doi:https://doi.org/10.1016/S0140-6736(21)01063-1
