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Clopidogrel alone cut bleeding but raised ischaemic events in A-CLOSE

A-CLOSE compared clopidogrel alone with continued dual therapy in people who had completed 12 months of dual antiplatelet treatment after a drug-eluting stent. The combined endpoint was nearly identical over the next 24 months, but its components moved in opposite directions: clopidogrel was linked to fewer bleeding events and more ischaemic events. Investigators said long-term treatment should be tailored to each person's bleeding and ischaemic risks.

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Macro view of a metallic coronary stent standing on a bright laboratory bench, with irregular clusters of unmarked white and pale-yellow tablets behind it.

The combined endpoint stayed level across the two treatments

A-CLOSE followed 3,203 high-ischaemic-risk people at 19 centres in South Korea, 12 months after they received a drug-eluting stent. One group took clopidogrel alone while the other continued dual antiplatelet therapy. Over the next 24 months, the combined endpoint of death, myocardial infarction, stent thrombosis, stroke or BARC type 2, 3 or 5 bleeding occurred in 5.0 per cent of the clopidogrel group and 5.1 per cent of the dual-therapy group. Clopidogrel alone was non-inferior on that measure.[1], [2]

Bleeding fell while ischaemic events rose

The components moved in different directions despite the similar combined result. The ischaemic endpoint was 3.7 per cent with clopidogrel alone and 1.6 per cent with continued dual therapy. The bleeding endpoint was 1.8 per cent in the clopidogrel group and 4.1 per cent in the dual-therapy group. Overall mortality was 1.3 per cent and 0.4 per cent respectively. The approach associated with less bleeding therefore came with more ischaemic events.[1]

Long-term treatment turns on each person's risks

Principal investigator Byeong-Keuk Kim said the results showed a clear trade-off and that long-term antiplatelet treatment should be individualised to a person's ischaemic and bleeding risks. Those enrolled had a mean age of 63, and 18.4 per cent were women. The investigator-initiated study was funded by a Cardiovascular Research Center grant in South Korea with support from two pharmaceutical companies. The findings were presented at ESC Congress 2026 and published in the New England Journal of Medicine.[1], [2]

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References

  1. News sourceEuropean Society of CardiologyAfter a year of double therapy, clopidogrel alone bled less and clotted more↩1↩2↩3
  2. News sourceNews-MedicalA-CLOSE results point to personalised antiplatelet therapy after stent implantation↩1↩2
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