image: SCAI Scientific Sessions 2026 & CAIC-ACCI Summit
Credit: Society for Cardiovascular Angiography & Interventions and Canadian Association of Interventional Cardiology
MONTREAL – April 24, 2026 – New findings show that switching to clopidogrel, a blood thinner, alone after one year of dual antiplatelet therapy (DAPT) leads to better outcomes than aspirin, even in patients at high risk of bleeding and those who had complex percutaneous coronary intervention (PCI). Researchers presented the late-breaking data today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions and Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d’intervention (CAIC-ACCI) Summit in Montreal.
Most patients who undergo PCI are prescribed DAPT to prevent blood clots from forming while the tissue around the stent heals. The duration of DAPT can vary based on a patient’s individual risk factors, balancing the risk of clotting against the risk of bleeding. Once the tissue has had time to heal and clotting risk decreases, patients may transition to a single medication, or monotherapy, in order to lower their risk of severe bleeding. For many years, aspirin has been the standard long-term single antiplatelet therapy, consistent with current guidelines. More recently, clopidogrel has emerged as an alternative option for select patients.
7,392 patients who received a standard duration of DAPT without adverse clinical events for one year following PCI with a drug-eluting stent were enrolled at Fuwai Hospital in Beijing, China. Patients who transitioned to antiplatelet monotherapy with either aspirin or clopidogrel were included in the analysis. The primary endpoint was net adverse clinical events (NACE), defined as a composite of major cardiovascular events including death, myocardial infarction, or stroke, as well as clinically relevant bleeding (BARC type two, three, or five) assessed between one and three years after PCI.
Of the 5,664 patients in the study who received antiplatelet monotherapy, 75.8% were male, 19.7% had a high risk of bleeding, and 34.5% had undergone complex PCI. A total of 3,690 patients were treated with aspirin monotherapy, and 1,974 received clopidogrel monotherapy. Patients were designated as high bleeding risk (HBR) if they met at least one major or two minor criteria from the HBR–Academic Research Consortium (ARC) definition. Complex PCI was defined by the presence of at least one of the following features: three or more stents implanted, three or more lesions treated, bifurcation with two stents implanted, total stent length more than 60 mm, or treatment of chronic total occlusion. Clopidogrel as compared with aspirin was associated with lower rates of thrombotic and bleeding events regardless of HBR and/or PCI complexity. No significant interactions were found between the treatment arms and the presence of HBR or PCI complexity.
The total population was classified into 4 groups based on the presence of HBR and PCI complexity: 3017 patients in the non–HBR and noncomplex PCI group (53.3%), 1534 in the non-HBR and complex PCI group (27.1%), 693 in the HBR and noncomplex PCI group (12.2%), and 420 in the HBR and complex PCI group (7.4%). In all 4 groups, clopidogrel monotherapy compared with aspirin monotherapy was associated with a lower risk of NACE. The occurrence of NACE was similar between those with high bleeding risk and those without. In addition, adverse event rates were similar between patients who underwent complex PCI and those who did not. The absolute magnitude of the net clinical benefit offered by clopidogrel monotherapy trended greater in patients at high bleeding risk who underwent complex PCI, and the interaction was significant. The beneficial impact of clopidogrel monotherapy was more pronounced in patients at higher risk and largest in those with the highest risk; patients with HBR who underwent complex PCI.
“For those patients who are event-free after completion of the standard duration of dual antiplatelet therapy, clopidogrel monotherapy was associated with fewer adverse events compared with aspirin,” said Hao-Yu Wang, MD, PhD, FSCAI, FACC, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, in Beijing. “The benefit is even more pronounced in patients with both high bleeding risk and complex procedures. To provide the best long-term protection for patients, clopidogrel seems to be considered over aspirin.”
Session Details:
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Friday, April 24; 4:45-4:53 PM ET
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Palais des Congrès de Montréal, 510b (5th Level)
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About Society for Cardiovascular Angiography & Interventions (SCAI)
The Society for Cardiovascular Angiography & Interventions, established in 1978, stands as the primary nonprofit medical society dedicated to representing invasive and interventional cardiology. SCAI's mission is to guide the global interventional cardiovascular community by fostering education, advocacy, research, and upholding standards for quality patient care. For more than 40 years, SCAI has exemplified professional excellence and innovation worldwide, cultivating a reputable community of over 5,000 members committed to advancing medical science and providing life-saving care for individuals, both adults and children, affected by cardiovascular disease.
For more information about the SCAI 2026 Scientific Sessions, visit https://www.scai.org/education-and-events/events-schedule/scai-2026-scientific-sessions-caic-acci-summit. Follow @SCAI on X for the latest heart health news and use #SCAI2026 to follow the latest discussions.