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Purpose <p>This study aimed to evaluate whether a 1-month course of ticagrelor or prasugrel followed by clopidogrel offers any clinical advantage over clopidogrel-based dual antiplatelet therapy (DAPT) in routine practice.</p> Methods <p>We conducted a retrospective, propensity-matched cohort study of ACS patients who underwent PCI between 2015 and 2021 at Chiang Rai Prachanukroh Hospital. Patients were grouped by their P2Y<sub>12</sub> regimen: 1-month potent P2Y<sub>12</sub> inhibitor (ticagrelor or prasugrel) followed by clopidogrel, or continuous clopidogrel-based DAPT. All patients received aspirin. Propensity score matching and Cox regression were used to adjust for confounders. The primary outcome was a composite of thrombotic readmission or all-cause mortality at 1&#xa0;year. Bleeding-related readmissions were assessed as the safety endpoint.</p> Results <p>A total of 1,117 patients were included. After matching, no significant differences were observed in the primary composite outcome across comparisons. In the clopidogrel vs. ticagrelor cohort (<i>n</i> = 161 per group), adjusted hazard ratio (HR) was 1.09 (95% CI: 0.56–2.11; <i>P</i> = 0.808). For clopidogrel vs. prasugrel (<i>n</i> = 139 per group), HR was 0.97 (95% CI: 0.43–2.22; <i>P</i> = 0.945). In the ticagrelor vs. prasugrel cohort (<i>n</i> = 275 per group), HR was 0.62 (95% CI: 0.33–1.17; <i>P</i> = 0.143). LVEF &lt; 40% and residual coronary disease were independently associated with adverse outcomes (HR 4.44 and 8.39, respectively).</p> Conclusion <p>A 1-month course of potent P2Y<sub>12</sub> inhibitor followed by clopidogrel was not superior to clopidogrel-based DAPT in reducing thrombotic readmission or mortality. Optimizing revascularization and heart failure therapy remains essential in high-risk patients.</p>

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Short-Course Potent P2Y12 Inhibitor–Based DAPT Versus Clopidogrel-Based DAPT After PCI: A Propensity-Matched Real-World Study

  • 期刊论文

  • 发表日期：

    2025年7月26日

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  • Natchanon Kulsumritpon

摘要

Purpose

This study aimed to evaluate whether a 1-month course of ticagrelor or prasugrel followed by clopidogrel offers any clinical advantage over clopidogrel-based dual antiplatelet therapy (DAPT) in routine practice.

Methods

We conducted a retrospective, propensity-matched cohort study of ACS patients who underwent PCI between 2015 and 2021 at Chiang Rai Prachanukroh Hospital. Patients were grouped by their P2Y12 regimen: 1-month potent P2Y12 inhibitor (ticagrelor or prasugrel) followed by clopidogrel, or continuous clopidogrel-based DAPT. All patients received aspirin. Propensity score matching and Cox regression were used to adjust for confounders. The primary outcome was a composite of thrombotic readmission or all-cause mortality at 1 year. Bleeding-related readmissions were assessed as the safety endpoint.

Results

A total of 1,117 patients were included. After matching, no significant differences were observed in the primary composite outcome across comparisons. In the clopidogrel vs. ticagrelor cohort (n = 161 per group), adjusted hazard ratio (HR) was 1.09 (95% CI: 0.56–2.11; P = 0.808). For clopidogrel vs. prasugrel (n = 139 per group), HR was 0.97 (95% CI: 0.43–2.22; P = 0.945). In the ticagrelor vs. prasugrel cohort (n = 275 per group), HR was 0.62 (95% CI: 0.33–1.17; P = 0.143). LVEF < 40% and residual coronary disease were independently associated with adverse outcomes (HR 4.44 and 8.39, respectively).

Conclusion

A 1-month course of potent P2Y12 inhibitor followed by clopidogrel was not superior to clopidogrel-based DAPT in reducing thrombotic readmission or mortality. Optimizing revascularization and heart failure therapy remains essential in high-risk patients.