Evidence map›Paper›PMID 39206792›Full record

SynthesisClinical cardiology2024

Clopidogrel Versus Aspirin as Monotherapy Following Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Receiving a Drug-Eluting Stent: A Systematic Literature Review and Meta-Analysis.

Dirk Sibbing, Johny Nicolas, Alessandro Spirito, Birgit Vogel, Davide Cao, Wanda Stipek, Ellen Kasireddy, Andi Qian, Irfan Khan, Roxana Mehran

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Antiplatelet Therapy in Heart Disease.Reviews in cardiovascular medicine · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Dirk SibbingDepartment of Internal Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
Johny NicolasDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Alessandro SpiritoDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Birgit VogelDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Davide CaoDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Wanda StipekSanofi, Bridgewater, New Jersey, USA.
Ellen KasireddyEvidinno Research Outcomes Inc., Vancouver, British Columbia, Canada.
Andi QianEvidinno Research Outcomes Inc., Vancouver, British Columbia, Canada.
Irfan KhanSanofi, Bridgewater, New Jersey, USA.
Roxana MehranDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Funding

This study was funded by Sanofi.
6 · The paper itself

Abstract

objectiveThis study aimed to evaluate the comparative effectiveness and safety of clopidogrel versus aspirin as monotherapy following adequate dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS).

methodsMEDLINE, Embase, and CENTRAL were searched from database inception to September 1, 2023. Randomized controlled trials (RCTs) and observational studies evaluating the effectiveness or safety of clopidogrel versus aspirin as monotherapy following DAPT in patients with ACS who received a drug-eluting stent were included. Random-effects meta-analyses were conducted to compare risks of major adverse cardiovascular events (MACE) and clinically relevant bleeding.

resultsOf 6242 abstracts identified, three unique studies were included: one RCT and two retrospective cohort studies. Studies included a total of 7081 post-percutaneous coronary intervention ACS patients, 4260 of whom received aspirin monotherapy and 2821 received clopidogrel monotherapy. Studies included variable proportions of patients with ST-elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. From the meta-analysis, clopidogrel was associated with a 28% reduction in the risk of MACE compared with aspirin (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), with no significant difference in clinically relevant bleeding (HR: 0.92; 95% CI: 0.68, 1.24).

conclusionDespite the paucity of published evidence on the effectiveness and safety of clopidogrel versus aspirin in patients with ACS post-drug-eluting stent implantation, this meta-analysis suggests that clopidogrel versus aspirin may result in a lower risk of MACE, with a similar risk of major bleeding. The present results are hypothesis-generating and further large RCTs comparing antiplatelet monotherapy options in ACS patients are warranted.

Indexed as

Acute Coronary SyndromeAspirinClopidogrelDrug-Eluting StentsPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsDual Anti-Platelet TherapyHemorrhageHumansTreatment OutcomeAspirinClopidogrelPlatelet Aggregation Inhibitorsacute coronary syndromeaspirinclopidogreldual antiplatelet therapymeta‐analysissingle antiplatelet therapysystematic review

Identifiers

PMID39206792
PMCPMC11358762

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.