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Thromb Haemost
DOI: 10.1055/a-2499-5458
Atherosclerosis and Ischaemic Disease

Optimal Long-term Antiplatelet Regimen for Patients with High Ischaemic and Bleeding Risks After Percutaneous Coronary Intervention

Jeong Yoon Jang 
1   Cardiovascular Centre, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
,
Ga-In Yu
1   Cardiovascular Centre, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
,
Jongwha Ahn
1   Cardiovascular Centre, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
,
Jae-Suck Bae
1   Cardiovascular Centre, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
,
Yun-Ho Cho
1   Cardiovascular Centre, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
,
Min-Gyu Kang
2   Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
,
Jin-Sin Koh
2   Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
,
Young-Hoon Jeong 
3   Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
,
Sang Yeup Lee
3   Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
,
Byeong-Keuk Kim
4   Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Hyung Joon Joo
5   Cardiovascular Center, Department of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
,
Do-Sun Lim
5   Cardiovascular Center, Department of Cardiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
,
Kiyuk Chang
6   Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
,
Young Bin Song
7   Division of Cardiology, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
,
Sung Gyun Ahn
8   Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
,
Jung-Won Suh
9   Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
,
Jung Rae Cho
10   Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
,
Ae-Young Her
11   Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
,
Jee-Hoon Kang
12   Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
,
Hyo-Soo Kim
12   Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
,
Moo Hyun Kim 
13   Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
,
Eun-Seok Shin
14   Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
,
Yongwhi Park
1   Cardiovascular Centre, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
,
On Behalf of the PTRG-DES Consortium Investigators › Institutsangaben Funding The study was designed by the principal investigator and executive committee and was sponsored by the Platelet- Thrombosis Research Group under the Korean Society of Intervention Cardiology.
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Abstract

Background

To assess an optimal long-term antiplatelet strategy in patients at both high ischaemic and bleeding risks after percutaneous coronary intervention (PCI).

Methods and Results

Patients at high risks of both ischaemia and bleeding were eligible for inclusion. We excluded patients with any ischaemic and major bleeding complications during the mandatory period of dual antiplatelet therapy (DAPT). Clinical outcomes were evaluated in three groups of regimens, namely, clopidogrel monotherapy (CLPD), aspirin monotherapy (ASA), and DAPT group. The primary endpoint was a composite of all-cause death, myocardial infarction, stroke, or major bleeding for 12-month follow-up period. To balance characteristics according to antiplatelet strategies, stabilized inverse probability treatment weighting (IPTW) was conducted. After IPTW adjustment, CLPD group (N = 916) showed significantly lower rate of primary endpoint than DAPT group (N = 949) (hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.22–3.60, p = 0.008), but there was no statistical difference between CLPD and ASA groups (N = 838) (HR = 1.46, 95% CI = 0.83–2.54, p = 0.187). Clinical benefits of CLPD over DAPT was mainly driven by the lower incidence of ischemic events (HR = 2.51, 95% CI 1.37–4.61; p = 0.003). Incidence of major bleeding did not differ among groups, but there was an increased bleeding tendency in DAPT group compared to CLPD group (HR = 2.51, 95% CI = 0.85–7.41, p = 0.096).

Conclusion

For patients at high bleeding and ischaemic risk, especially undergoing complex PCI, clopidogrel monotherapy demonstrated a significant net clinical benefit compared to DAPT. Clopidogrel monotherapy showed numerical reductions of bleeding and ischaemic event rates compared to aspirin monotherapy.

Keywords

long-term antiplatelet therapy - high ischaemic risk - high bleeding risk - percutaneous coronary intervention - dual antiplatelet therapy

Data Availability Statement

All data are incorporated into the article and its online [Supplementary Material] (available in the online version).


Authors' Contribution

Y.P. and J.A. conceived the study. J.Y.J., J.S.B., and Y.H.C. designed and conducted data collection. G.Y. conducted data analysis and provided interpretations of the data. J.Y.J. drafted the first version of the manuscript. All authors critically revised the manuscript for intellectually important content and approved the final version to be published.


Supplementary Material



Publikationsverlauf

Eingereicht: 18. Juli 2024

Angenommen: 10. Dezember 2024

Accepted Manuscript online:
10. Dezember 2024

Artikel online veröffentlicht:
24. März 2025

© 2025. Thieme. All rights reserved.

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