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Getting the latest healthcare news for you
Getting the latest healthcare news for you
Think twice before scaling back blood thinners after a stent. The A-CLOSE trial found that switching high-ischemic-risk patients from dual antiplatelet therapy (DAPT) to clopidogrel alone after 12 months led to more than twice the rate of ischemic events — including heart attacks and stent thrombosis — despite less bleeding. Experts say a one-size-fits-all deescalation approach may not be right for everyone.
Scaling back blood thinners after a stent? Not so fast for high-risk patients.
The A-CLOSE trial, presented at the European Society of Cardiology Congress and published in The New England Journal of Medicine, examined a common clinical dilemma: when to scale back antiplatelet therapy after a drug-eluting stent (DES). The study enrolled 3,203 high-ischemic-risk patients who had already completed 12 months of dual antiplatelet therapy (DAPT) and randomized them to either clopidogrel monotherapy or continued DAPT (clopidogrel + aspirin) for another 24 months.
While clopidogrel monotherapy met the bar for noninferiority on the combined net adverse clinical event endpoint, the ischemic picture told a different story — patients on monotherapy had significantly more heart attacks, stent thromboses, and deaths. The bleeding benefit was real, but experts caution it shouldn't drive routine deescalation in this population.
By the Numbers:
Why it matters: These findings challenge the growing trend of routine antiplatelet deescalation and underscore the need for individualized treatment decisions — weighing each patient's ischemic vs. bleeding risk rather than applying a blanket protocol.
