Efficacy and Safety of Dual Antiplatelet Therapy in High-Risk, Post-Percutaneous Coronary Intervention Patients beyond One Year

Background: Individuals with coronary artery disease (CAD) who have undergone a percutaneous coronary intervention (PCI) are at an increased risk for adverse coronary events. Management with dual antiplatelet therapy (DAPT) has been indicated in this group, however, DAPT significantly increases the risk of bleeding. Objectives: This study aimed to evaluate aspirin versus clopidogrel and aspirin on major adverse cardiac and cerebrovascular events (MACCE) and risk of bleeding in individuals already on DAPT for one year after undergoing PCI. Methods: This was a single-center, double-arm, interventional, prospective study. A total of 956 individuals who had undergone PCI and were on DAPT for a year were enrolled. After calculating DAPT scores, individuals with DAPT scores ≥2 were assigned to the aspirin and clopidogrel group, and those with DAPT scores <2 were prescribed aspirin alone. The participants were followed for one year to collect data on incidences of MACCE and significant bleeding. Results: The group on clopidogrel and aspirin demonstrated a significantly lower rate of MACCE when compared to those on aspirin alone (p = 0.003). However, stent thrombosis, stroke, and myocardial infarction (MI) did not significantly differ in an inter-group comparison. The rate of moderate bleeding was greater in the clopidogrel group; however, the difference was not found to be statistically significant (p = 0.19). Conclusions: Continuing DAPT for a period between 12 and 24 months after PCI in individuals with a DAPT score ≥2 had favorable outcomes in reducing coronary adverse events without resulting in significant bleeding.