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Ney Carter Borges: Clopidogrel vs Aspirin in Long-Term Monotherapy
Ney Carter Borges/LinkedIn
Mar 31, 2026, 15:57

Ney Carter Borges: Clopidogrel vs Aspirin in Long-Term Monotherapy

Ney Carter Borges, Member Cardiologist of Global Physician Association at Cleveland Clinic Florida, shared a post on LinkedIn:

“HOST-EXAM 10-Year Study – ACC 26

The HOST-EXAM trial is a randomized, open-label, multicenter study evaluating the optimal long-term antiplatelet monotherapy after PCI with drug-eluting stents (DES). It compared clopidogrel versus aspirin in patients who remained event-free after 6–18 months of dual antiplatelet therapy (DAPT).

A total of 5,438 patients were randomized (2,710 clopidogrel vs. 2,728 aspirin), with a median follow-up of 10.5 years, representing one of the longest datasets in contemporary coronary intervention.

Key Results (10-year, intention-to-treat)

  • Primary composite endpoint (POCO)
  • Clopidogrel: 25.4%
  • Aspirin: 28.5%
  • HR 0.86 (95% CI 0.77–0.96), p=0.005
  • Absolute risk reduction: 3.1%
  • NNT ≈ 33
  • Thrombotic events
  • HR 0.82 (95% CI 0.72–0.93), p=0.002
  • Any bleeding (BARC ≥2)
  • HR 0.81 (95% CI 0.68–0.97), p=0.020
  • Major bleeding (BARC ≥3)
  • HR 0.71 (95% CI 0.57–0.88), p=0.002
  • All-cause mortality
  • No significant difference
  • HR 1.07 (p=0.40)

Notably, stroke reduction—especially hemorrhagic stroke—was significantly lower with clopidogrel.

Per-Protocol Analysis (More pronounced effect)

Primary endpoint:

  • 24.0% vs. 29.8%
  • HR 0.76 (p<0.001)
  • NNT ≈ 17

Consistent reductions in:

  • MI
  • Stroke (HR ~0.52)
  • Bleeding events

Clinical Interpretation

This study challenges the traditional paradigm of aspirin as default lifelong therapy post-PCI.
Over a decade:

  • Clopidogrel demonstrated sustained superiority
  • Benefit was dual:
    Decreased ischemic events
    Decreased bleeding events
  • No mortality benefit, but clear reduction in morbidity

Importantly, benefits persisted beyond the randomized phase (post-trial period), reinforcing biological plausibility and durability of effect.

Limitations

  • Open-label design (potential bias in softer endpoints)
  • No pharmacogenetic testing (CYP2C19)
  • Post-trial treatment heterogeneity
  • Predominantly East Asian population (generalizability considerations)

Final Take-Home Message

In stable CAD patients post-PCI who are event-free after DAPT:

  • Clopidogrel is superior to aspirin as long-term monotherapy
  • Provides net clinical benefit (ischemia with bleeding)
  • Should be strongly considered as preferred maintenance therapy”

Ney Carter Borges

Other posts featuring Net Carter Borges on Hemostasis Today.

ACC.26 Aspirin bleeding Blood CAD Cardiology clopidogrel Health Hematology Hemophilia Hemostasis Hemostasis News Hemostasis Today HOST-EXAM Ischemic Events Medicine Myocardial infarction Ney Carter Borges PCI stroke thrombosis
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