Antiplatelet monotherapy after DAPT: is clopidogrel the new standard? Pros and cons

Introduction

Antiplatelet monotherapy is the standard of care for secondary prevention after an initial course of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome or undergoing percutaneous coronary intervention (PCI). Aspirin has long been the drug of choice for this purpose and is still recommended under Class I by guidelines. However, randomised trials and meta-analyses suggested a potential benefit with clopidogrel, a P2Y12 receptor inhibitor. As such, a Class IIb recommendation supporting the use of clopidogrel for long-term secondary prevention has been yielded by the latest guidelines. Nevertheless, limitations regarding enrolled populations and study design should be considered when interpreting such findings. Whether current evidence is enough to advocate the routine use of clopidogrel instead of aspirin for long-term secondary prevention is a matter for debate.

Pros

Hyo-Soo Kim, MD; Jeehoon Kang, MD

Medical treatment including antithrombotic therapy after PCI is essential in preventing recurrence. After the initial period of intensive antithrombotic therapy (usually DAPT), antiplatelet monotherapy is used as secondary prevention.

Guidelines “still” state that aspirin should be the first-line antiplatelet agent for secondary prevention