After DAPT: Clopidogrel vs. Aspirin Monotherapy Following PCI (SCAI 2026)
One of the more practice-relevant threads from the 2026 SCAI Scientific Sessions (Montréal) was the continued re-examination of which single antiplatelet agent should be continued once dual antiplatelet therapy (DAPT) is complete after PCI. In the SCAI 2026 late-breaking roundup, investigators compared long-term clopidogrel monotherapy with aspirin monotherapy following completion of DAPT.
The reported signal: across multiple patient populations — including patients at high bleeding risk and those who underwent complex PCI — clopidogrel monotherapy showed favourable net clinical outcomes versus aspirin monotherapy. This adds to an accumulating body of evidence (and parallels ongoing discussion captured in ACC's July 2026 Eagle's Eye View podcast, "Clopidogrel vs. Aspirin Following PCI") supporting P2Y12-inhibitor monotherapy as the maintenance strategy after the initial DAPT window, rather than defaulting to lifelong aspirin.
Why this is clinically interesting. Aspirin has been the reflexive "forever" agent after stenting, but a growing set of trials suggests a P2Y12 inhibitor alone may deliver comparable or better ischaemic protection with a similar or improved bleeding profile once the early high-risk period has passed. If confirmed and incorporated into guidelines, this would shift long-term secondary-prevention prescribing after PCI.
Caveats. This is late-breaking, trial-level evidence summarised in a meeting roundup; exact populations, follow-up duration, endpoint definitions, and effect sizes must be read from the primary presentation/publication before any change in practice. Antiplatelet selection also interacts with clopidogrel metabolism (CYP2C19), cost, and adherence — all relevant in our setting.
Why it matters for central Gujarat patients
Many post-PCI patients here remain on aspirin indefinitely by default. A well-tolerated single-agent P2Y12 strategy could matter for patients with bleeding risk (elderly, prior GI bleed, concomitant anticoagulation). Generic clopidogrel is widely available and affordable locally, so any guideline shift would be practically implementable — but CYP2C19 loss-of-function variants are common in South Asian populations and warrant consideration.
Sources
- ACC Cardiology Magazine — "SCAI 2026 Roundup: Major Coronary, Structural and Vascular Trials From Montréal" (Alraies MC), Jul 1, 2026: https://www.acc.org/Latest-in-Cardiology/Articles/2026/07/01/01/Online-Exclusive-SCAI-2026-Roundup
- ACC Eagle's Eye View podcast — "Clopidogrel vs. Aspirin Following PCI," Jul 1, 2026: https://www.acc.org/latest-in-cardiology/articles/2026/07/01/12/47/eagles-eye-view-01jul2026