STOPDAPT-3 one-year results support similar efficacy and safety of aspirin and clopidogrel after percutaneous coronary intervention

Graphical AbstractInhibiting platelet thromboxane (TX)A2 synthesis with low-dose aspirin or blocking the P2Y12 receptor for adenosine diphosphate (ADP) with ticagrelor or clopidogrel has similar effects on cardiovascular and bleeding outcomes. (A) The activation of platelets is induced by the interaction of several agonists with receptors expressed on the platelet membrane and depicts outside-in signalling mediated by TXA2, ADP, and thrombin. The TXA2-evoked increase in intracellular Ca2+ and ADP-induced decrease in cAMP levels independently lead to platelet aggregation through a change in the ligand-binding properties of the glycoprotein IIb/IIIa (αIIbβ3), which acquires the ability to bind soluble adhesive proteins such as circulating fibrinogen. The secondary release of ADP and TXA2 induces further platelet activation and aggregation, thereby amplifying the initial activation signal(s).8 (B) The main efficacy (left graph) and safety (right graph) results of the GLOBAL LEADERS trial,11 a randomized comparison of ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs. aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months. (C) Time-to-event curves of the co-primary cardiovascular (left graph) and bleeding (right graph) endpoints for the overall 1-year analysis of the intention-to-treat population of the STOPDAPT-3 trial.10 (A) Redrawn from Davì and Patrono;8 (B) taken from the GLOBAL LEADERS presentation at the 2018 ESC Congress through the courtesy of Professor Marco Valgimigli; (C) reproduced from Watanabe et al.10 in the current issue of the European Heart Journal