Clinical outcomes with the use of aspirin vs. clopidogrel as a combination therapy with direct oral anticoagulant after coronary stent implantation in patients with atrial fibrillation

Aims Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) are recommended to receive double antithrombotic therapy including an antiplatelet agent and direct oral anticoagulants (DOAC). The efficacy and safety of aspirin vs. clopidogrel as a combination therapy with DOAC were compared in the present study. Methods and results Patient data from the Korea National Health Insurance Service from 2013 to 2020 were analysed. A total of 9157 patients with AF who received double antithrombotic therapy consisting of an antiplatelet agent and a DOAC after PCI were included. Patients were classified into the clopidogrel or aspirin group and 1:1 propensity score (PS) matching was performed. The major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, ischaemic stroke, or systemic thromboembolism. After PS matching, the clopidogrel and aspirin groups consisted of 2882 patients each. During a median follow-up of 20.1 months, the incidence of MACE was not significantly different between the two groups (hazard ratio [HR] for clopidogrel group 0.91, 95% confidence interval [CI] 0.81-1.02). The incidence of ischaemic endpoints did not significantly differ between the two groups. A significant difference was not observed in the incidence of major bleeding events (HR 0.94, 95% CI 0.78-1.12) and net adverse clinical events (HR 0.93, 95% CI 0.84-1.03). Conclusion In patients with AF receiving double antithrombotic therapy after PCI, aspirin and clopidogrel showed similar efficacy and safety when used in combination with DOAC.