Clopidogrel vs. aspirin in addition to oral anticoagulation as part of double antithrombotic therapy following PCI: a post-hoc analysis of the PERSEO registry

In patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI), clopidogrel is currently the preferred antiplatelet agent to be given in double antithrombotic therapy (DAT). To explore whether aspirin could be an alternative option, a post-hoc analysis of the Italian, multi-center, prospective PERSEO (PERcutaneouS coronary intErventions in patients treated with Oral anticoagulant therapy) registry was performed. Out of the 989 patients included in the analysis, 769 (78%) received clopidogrel and 220 (22%) aspirin. Baseline characteristics were largely comparable between the two groups, particularly as regards the indications for PCI and OAC, with acute coronary syndrome and atrial fibrillation respectively, being the most common, the number of stents implanted, and the use of direct oral anticoagulants and proton-pump inhibitors. At a median follow-up of 12.3 months, the primary outcome of net adverse cardiac events (NACE), including major adverse cardiac/cerebral events (MACCE) and major and clinically relevant bleeding was similar with clopidogrel-based and aspirin-based DAT (16.3% vs. 14.6%; p = 0.541). Secondary outcomes of MACCE, all-cause death, cardiac death, non-fatal myocardial infarction, stent thrombosis, non-fatal stroke/transient ischemic attack, target vessel revascularization, and major and clinically relevant bleeding were also comparable. Multivariable analyses confirmed no association between type of DAT and outcomes. Survival analyses showed overlapping event rates between clopidogrel-based and aspirin-based DAT. In patients on OAC undergoing PCI, no significant difference in the occurrence of NACE was observed between clopidogrel-based and aspirin-based DAT. While waiting for further randomized data, individualized physician’s choice may be considered on an individual basis.