Evidence map›Paper›PMID 41760043›Full record

SynthesisMedicine2026

Antiplatelet dilemma: Clopidogrel or aspirin for long-term cardiovascular protection after dual antiplatelet therapy following PCI.

Mostafa Hossam El Din Moawad, Mahmoud Elsayed, Ibrahim Serag, Reham M Wagih, Abdelrahman Elgharabawi, Yousr Ahmed, Abdelrahman Elkholy, Ahmed Abdelraouf, Areej M Alsolami, Ahmed Alattar and 7 more

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. 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

17 authors.

Mostafa Hossam El Din MoawadAlexandria Main University Hospital, Alexandria, Egypt.
Mahmoud ElsayedStroke and Neurovascular Regulation Laboratory, Charlestown, MA.
Ibrahim SeragFaculty of Medicine, Mansoura University, Mansoura, Egypt.
Reham M WagihDepartment of Total Parenteral Nutrition, Alexandria Main University Hospital, Alexandria, Egypt.
Abdelrahman ElgharabawiFaculty of Biology, Medicine and Health, Manchester University, Manchester, The United Kingdom.
Yousr AhmedDepartment of Pulmonology and Critical Care, Johns Hopkins University, Baltimore, MD.
Abdelrahman ElkholyFaculty of Medicine, Alexandria University, Alexandria, Egypt.
Ahmed AbdelraoufFaculty of Medicine, Al-Azhar University, Cairo, Egypt.
Areej M AlsolamiDepartment of Biology, College of Science, Jouf University, Saudia Arabia.
Ahmed AlattarKing Abdullah Medical City, Makkah, Saudi Arabia.
Ibraheem M AlkhawaldehFaculty of Medicine, Mutah University, Al-Karak, Jordan.
Hamza A Abdul-HafezDepartment of Medicine, An-Najah National University, Nablus, West Bank, Palestine.ORCID 0009-0003-6089-240
Ahmed Farid GadelmawlaFaculty of Medicine, Menoufia University, Menoufia, Egypt.
Mohamed AbouzidDepartment of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Poznan, Poland.
Mohamed O MohamedInstitute of Health Informatics, University College London, London, UK.
Osama BishtEvangelisches Herzzentrum Coswig, Teilen Speichern, Coswig (Anhalt), Germany.
Mohammed ElkholyDepartment of Radiology, The Laboratory for Minimally Invasive Tumor Therapies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe optimal choice of antiplatelet monotherapy after dual antiplatelet therapy (DAPT) among patients undergoing PCI remains debatable. While aspirin has long been the default choice, clopidogrel has emerged as a potential alternative due to its lower bleeding risk and possible superior ischemic protection. This meta-analysis sought to investigate the recent findings comparing the use of aspirin against clopidogrel after different durations of DAPT in patients who underwent PCI.

methodsWe searched for randomized controlled trials and cohort studies comparing long-term aspirin and clopidogrel monotherapy after DAPT post-PCI. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included major and minor bleeding, gastrointestinal (GI) bleeding, stroke, myocardial infarction (MI), target vessel revascularization, and stent thrombosis.

resultsSix studies comprising 14,992 patients were included. Clopidogrel monotherapy was associated with a significantly lower risk of MACE than aspirin (risk ratio [RR]: 1.24; 95% CI: 1.09-1.42; P = .001). Aspirin monotherapy resulted in a higher risk of minor bleeding (RR: 1.57; 95% CI: 1.06-2.34; P = .03) and GI bleeding (RR: 1.19; 95% CI: 1.04-1.37; P = .01). However, aspirin monotherapy was associated with a higher risk of stroke, including both ischemic (RR: 1.56; 95% CI: 1.03-2.38; P = .04) and hemorrhagic stroke (RR: 2.06; 95% CI: 1.06-3.98; P = .03).

conclusionClopidogrel monotherapy appears to be a superior alternative to aspirin for long-term secondary prevention after PCI, offering a lower risk of MACE and stroke without increasing major bleeding or mortality. However, individual factors such as genetic variability, GI bleeding risk, and cost should guide therapy selection.

Indexed as

AspirinCardiovascular DiseasesClopidogrelDual Anti-Platelet TherapyPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsDrug Therapy, CombinationGastrointestinal HemorrhageHemorrhageHumansMyocardial InfarctionRandomized Controlled Trials as TopicStrokeAspirinClopidogrelPlatelet Aggregation Inhibitorsaspirinbleedingclopidogreldual antiplatelet therapymajor adverse cardiovascular eventspercutaneous coronary interventionstroke

Identifiers

PMID41760043
PMCPMC12956167

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.