The 10-year follow-up of the HOST-EXAM trial compares clopidogrel versus aspirin monotherapy in patients after percutaneous coronary intervention (PCI). Results demonstrate sustained reductions in composite ischaemic and bleeding outcomes with clopidogrel, with no mortality difference between the two agents. These long-term data challenge the historical primacy of aspirin in chronic secondary prevention post-PCI. Clinicians should consider clopidogrel as a preferred monotherapy option for long-term management following PCI.
The 10-year follow-up of the HOST-EXAM trial by Jeehoon Kang and colleagues1 provides the longest randomised comparison of clopidogrel and aspirin monotherapy after percutaneous coronary intervention, demonstrating sustained reductions in composite ischaemic and bleeding outcomes with clopidogrel without a mortality signal. These findings extend previous observations from trials such as HOST-EXAM,2 SMART-CHOICE 3,3 and STOPDAPT-2,4 as well as individual patient-level meta-analyses,5 collectively challenging the long-standing primacy of aspirin in chronic secondary prevention.
