Severance Hospital study suggests personalized antiplatelet therapy for high-risk stent patients

A research team from Severance Hospital has demonstrated that high-risk patients who have undergone coronary stent procedures require personalized long-term antiplatelet therapy to balance ischemic and bleeding risks.

The A-CLOSE study, a multicenter randomized clinical trial involving 3,203 high-risk patients across 19 South Korean institutions, compared clopidogrel monotherapy against extended dual antiplatelet therapy (DAPT) over a 24-month follow-up period. While the overall rate of primary composite clinical events was similar between the two groups (5% for monotherapy vs. 5.1% for extended DAPT), the specific outcomes differed significantly.

Extended DAPT reduced major ischemic events—including death, myocardial infarction, stent thrombosis, and stroke—by more than half compared to monotherapy. Specifically, the risk of major ischemic events was 2.33 times higher in the clopidogrel monotherapy group (3.7%) than in the extended DAPT group (1.6%). Conversely, monotherapy reduced the risk of clinically significant bleeding by 57% compared to extended DAPT (1.8% vs. 4.1%).

The findings, presented at the ESC Congress 2024 and published in the New England Journal of Medicine, suggest that clinicians should not transition all patients to monotherapy after one year but should instead tailor treatment based on individual risk profiles.