Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial

Koo, Bon‐Kwon; Kang, Jeehoon; Park, Kyung Woo; Rhee, Tae‐Min; Yang, Han–Mo; Won, Ki‐Bum; Rha, Seung Woon; Bae, Jang‐Whan; Lee, Nam Ho; Hur, Seung‐Ho; Yoon, Junghan; Park, Tae-Ho; Kim, Bum Soo; Lim, Sang Wook; Cho, Yoon Haeng; Jeon, Dong Woon; Kim, Sang-Hyun; Han, Jung‐Kyu; Shin, Eun‐Seok; Kim, Hyo–Soo; Lee, Heesun; Han, Kyoo‐Rok; Moon, Keon-Woong; Oh, Seok; Kim, Ung; Rhee, Moo-Yong; Kim, Doo-Il; Kim, Song-Yi; Lee, Sungyun; Lee, Seung Uk; Kim, Sang–Wook; Kim, Seok Yeon; Jeon, Hui-Kyung; Soo, Kwang; Jo, Sang‐Ho; Ryu, Jae Kean; Suh, Il-Woo; Choi, Hyun–Hee; Woo, Seoung-Il; Chae, In‐Ho; Shin, Won-Yong; Kim, Dae-Kyeong; Oh, Ju Hyeon; Jeong, Myung Ho; Kim, Yong Hoon

doi:10.1016/s0140-6736(21)01063-1

Cited by 214 publications

(203 citation statements)

References 27 publications

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“…Therefore, the conclusion that P2Y 12 receptor inhibitor monotherapy is better than aspirin monotherapy after 1-3 months DAPT is not enough, which is an indirect comparison by subgroup analysis. The HOST-EXAM trial is the first trial that directly compared these two short-term DAPT strategies, which showed that clopidogrel monotherapy after short-term DAPT can significantly reduce the incidence of the primary outcome (HR, 0.73 0.59-0.9) compared with aspirin monotherapy after short-term DAPT (22). However, whether ticagrelor or prasugrel monotherapy after short-term DAPT is also superior to aspirin monotherapy after shortterm DAPT is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Very Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stents Implantation for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Zhong

Shang

Bai

et al. 2021

Front. Cardiovasc. Med.

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Background and Objective: Dual antiplatelet therapy (DAPT) is the basis for preventing ischemic events after percutaneous coronary intervention (PCI), and DAPT for 12 months has been the standard strategy recommended by the guidelines. However, patients with acute coronary syndrome (ACS) have a higher risk of thrombosis, and the application of very short-term DAPT (1–3 months) in patients with ACS is consistently controversial. The purpose of this study is to explore the efficacy and safety of DAPT for 1–3 months in patients with ACS who were implanted with drug-eluting stents (DES).Methods: We conducted a systematic review and meta-analysis of randomized controlled trials that compared the very short-term (3 months or less) with long-term (12 months or more) DAPT in patients with ACS after PCI. The randomized controlled trials were included by searching PubMed, EMBASE, and Cochrane Library database. The relative risk (RR) and 95% CIs for endpoint events were calculated by the fixed effects model, and trial sequential analysis was applied to calculate the anticipated sample size and assess the results.Result: A total of eight randomized controlled trials with 16,492 patients who met the inclusion criteria were conducted. There were no significant statistic differences in myocardial infarction (RR 1.05, 0.82–1.35, P = 0.68), stents thrombosis (RR 1.32, 0.85–2.07, P = 0.22), all-cause death (RR 0.87, 0.66–1.13, P = 0.29), and target vessel revascularization (RR 0.93, 0.76–1.13, P = 0.47). However, there were significant differences in major bleeding (RR 0.60, 0.50–0.73, P < 0.00001) and the net adverse cardiac and cerebrovascular events (RR 0.84, 0.74–0.95, P = 0.007).Conclusions: The strategy of DAPT for 1–3 months not only has a significant effect in patients with ACS who were implanted with DES but also reduces the risk of major bleeding. The scheme of short-term DAPT followed by P2Y12 receptor inhibitor monotherapy is especially beneficial for patients with ACS. The results of this systematic review and meta-analysis are based on the application of new generation DES and new oral antiplatelet drugs in patients with ACS, which are difficult to use in the general population (Registered by PROSPERO, CRD 42020210520).Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD 42020210520.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Very Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stents Implantation for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Zhong

Shang

Bai

et al. 2021

Front. Cardiovasc. Med.

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“…[ 34 – 37 ] For our consensus statements, the primary references were TWILIGHT, SMART-CHOICE, and two other Asian trials: STOPDAPT-2 and HOST-EXAM. [ 34 , 36 , 38 , 39 ]…”

Section: Consensus Statementsmentioning

confidence: 99%

“…HOST-EXAM (NCT02044250) was an open-label, single-blind, randomised trial conducted in South Korea among 5,438 adult participants. [ 39 ] Prior to enrolment, the subjects had undergone PCI for either ACS (~72%) or CCS (~28%) and had already been taking DAPT using aspirin and a P2Y 12 inhibitor (clopidogrel ~82%, ticagrelor ~10%, prasugrel ~8%) for 6–18 months, without any ischaemic or haemorrhagic complication. [ 39 ] They were then randomly assigned to receive either clopidogrel or aspirin monotherapy for 24 months.…”

Section: Consensus Statementsmentioning

confidence: 99%

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

et al. 2021

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Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy.

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“…The Harmonising Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy study was an investigator-initiated, multicentre, prospective, randomised, open-label trial conducted at 37 sites in South Korea. 18 The population included patients>20 years of age who had been maintained on DAPT with aspirin plus any P2Y12 inhibitor for 6–18 months following PCI with a DES. Patients with ischaemic or bleeding events were excluded from randomisation.…”

Section: Contemporary Antiplatelet Therapy Trialsmentioning

confidence: 99%

Sex-based outcomes in contemporary antiplatelet therapy trials

Alasnag

Jones

Hanfi³

et al. 2021

Open Heart

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Balancing ischaemic and bleeding risks in high-risk populations undergoing percutaneous coronary interventions has become an everyday dilemma for clinicians. It is particularly difficult to make decisions concerning combinations and duration of antiplatelet regimens in women given the poor representation of women in trials that have shaped current practice. Several contemporary landmark trials have recently been presented at the American College of Cardiology. The trials included the Harmonising Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy, Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention and the TicAgrelor versus CLOpidogrel in Stabilised Patients With Acute Myocardial Infarction. In this article, we summarise the main findings of these trials and include the The Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk (LEADERS FREE) in search for evidence based best practices for women patients. Although some of these trials had prespecified a subanalysis of sex differences, women constituted only 17%–30% of participants making sex-specific analyses challenging. Data suggest that women benefit from de-escalation to both ticagrelor and clopidogrel monotherapy. However, given the increased bleeding risks observed in women further randomised controlled trials are necessary to determine the most appropriate combination and duration of dual antiplatelet therapy as well as maintenance single antiplatelet therapy.

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Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial

Cited by 214 publications

References 27 publications

Efficacy and Safety of Very Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stents Implantation for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Efficacy and Safety of Very Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stents Implantation for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

Sex-based outcomes in contemporary antiplatelet therapy trials

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