ABSTRACT
Background: Acute coronary syndrome (ACS) in patients with both high ischemic and bleeding risks presents a therapeutic challenge. Dual antiplatelet therapy (DAPT) is the standard treatment, but monotherapy with clopidogrel has been proposed as a safer alternative to mitigate bleeding complications while maintaining efficacy.
Aim: This study aimed to evaluate the efficacy and safety of clopidogrel monotherapy compared to DAPT in patients with double-risk ACS, assessing clinical outcomes, including ischemic events and bleeding complications.
Methods: This comparative analysis was conducted at Services Hospital Lahore from October 2023 to September 2024. A total of 50 patients diagnosed with double-risk ACS were enrolled and divided into two groups: one receiving clopidogrel monotherapy and the other receiving standard DAPT. Clinical outcomes, including major adverse cardiovascular events (MACE), bleeding complications (as per the BARC classification), and all-cause mortality, were assessed over a 12-month follow-up period. Statistical analysis was performed to compare efficacy and safety between the two treatment regimens.
Results: Clopidogrel monotherapy demonstrated non-inferior efficacy compared to DAPT, with no significant difference in the incidence of MACE between the two groups (p > 0.05). However, the monotherapy group exhibited a significantly lower rate of major bleeding events (p < 0.05), suggesting a superior safety profile. There was no significant difference in all-cause mortality between the two treatment arms.
Conclusion: Clopidogrel monotherapy was found to be a viable alternative to DAPT in managing double-risk ACS, offering comparable efficacy while significantly reducing bleeding complications. These findings support its potential use in high-bleeding-risk patients where standard DAPT poses safety concerns. Further large-scale studies are warranted to validate these results.
Keywords: Acute Coronary Syndrome, Clopidogrel Monotherapy, Dual Antiplatelet Therapy, Major Adverse Cardiovascular Events, Bleeding Risk, Clinical Outcomes