Is clopidogrel better than aspirin for long-term treatment after cardiac stenting?

This study looked at which antiplatelet drug is better in patients who had percutaneous coronary intervention (PCI). It found that patients who had maintenance treatment with clopidogrel (Plavix) were less likely to suffer from a heart attack, bleeding, stroke, or death over the following 24 months compared to those treated with aspirin.

Percutaneous coronary intervention (PCI) is a procedure used to unblock arteries in the heart. It involves placing a stent into the artery to keep it open. One risk with PCI is that blood clots can form on the stent and cause a blockage. Antiplatelet agents are a type of medication used to prevent this. 

Aspirin and clopidogrel are two of the most commonly used antiplatelet agents. Usually, both aspirin and clopidogrel are used together for the first several months after PCI. Then the treatment is reduced to either aspirin or clopidogrel for long-term maintenance treatment. It is not clear which of these medications is more effective for long-term treatment.

5,438 patients were involved in this study. All patients had had a previous PCI, after which they had been treated with both aspirin and clopidogrel for 6-18 months. Then, patients were divided into two groups. Group 1 received aspirin only, group 2 received clopidogrel only. The main outcome evaluated was the occurrence of a major cardiovascular event (MACE). MACE includes heart attacks, strokes, a second blockage of a blood vessel in the heart, bleeding, or death.

After 24 months of treatment, 5.7% of the clopidogrel group had a MACE, compared to 7.7% of the aspirin group. Clopidogrel was associated with a 27% lower risk of MACE compared to aspirin.

Fewer patients treated with clopidogrel had gastrointestinal side effects such as stomach pain, nausea, vomiting, diarrhea, constipation, or bleeding compared to the aspirin group.  

This study showed that clopidogrel may be more effective than aspirin for long-term maintenance treatment after PCI. 

This study was based on an Asian population. Further studies are required to see if these results apply to other ethnicities.