When a myocardial infarction occurs, patients undergo a stent procedure to unblock the artery and take aspirin for life to prevent the formation of blood clots (thrombus). Domestic researchers have found a better method than existing treatment guidelines. They investigated approximately 30,000 patients worldwide who underwent stent procedures and revealed that other medications are more effective in preventing myocardial infarction recurrence.
Researchers, including Professors Han Ju-yong, Song Young-bin, and Choi Ki-hong from the Cardiovascular Center at Samsung Medical Center, noted that "an analysis of 28,982 patients worldwide who received stent procedures found that long-term use of clopidogrel instead of aspirin as an antiplatelet agent could reduce the risk of cardiovascular death, myocardial infarction, and stroke by an additional 14%," as published in the international journal 'Lancet' on the 1st.
Aspirin, a pain reliever developed by Bayer in Germany in 1897, has the effect of preventing blood clotting and is used as an antiplatelet agent for preventing myocardial infarction and stroke. Clopidogrel is also an antiplatelet agent developed by Sanofi in France, widely known by its brand name Plavix. Its patent expired in the United States in 2011, and there are now many affordable generic versions.
The researchers analyzed seven randomized clinical trials on patients who underwent stent procedures to determine which medication is better for preventing myocardial infarction or stroke. Myocardial infarction is a condition where the coronary artery, which supplies blood to the heart muscle, is blocked, causing damage to the heart muscle. Stroke is a condition where a blood vessel to the brain is blocked, leading to damage to the brain tissue.
In cases of sudden myocardial infarction, a stent is inserted into the blood vessel to unblock it. After the procedure, antiplatelet agents are administered to prevent re-clotting. Platelets are cell fragments that help blood clotting and the formation of blood clots. Typically, both aspirin and clopidogrel are taken together for six months to a year, after which one of them is taken for life.
Until now, patients who underwent stent procedures took two antiplatelet agents together and then switched to only one after a certain period. Among the patients analyzed by the researchers, 14,475 were taking aspirin, while 14,507 were taking clopidogrel.
The analysis found that patients taking clopidogrel long-term had a 24% lower probability of experiencing myocardial infarction compared to those taking aspirin. Strokes occurred 21% less frequently. The effectiveness of antiplatelet agents is associated with an increased risk of bleeding. There was no significant difference in bleeding rates between clopidogrel and aspirin.
U.S. treatment guidelines recommend taking two antiplatelet agents initially and later continuing with aspirin for life. In this regard, the study presents new treatment guidelines. Professor Han Ju-yong stated, "We have shown that clopidogrel monotherapy is superior to aspirin based on approximately 30,000 patients from various ethnic backgrounds."
References
Lancet(2025), DOI : https://doi.org/10.1016/S0140-6736(25)01562-4