PANTHER: Should Clopidogrel Become the ‘New Aspirin’ in CAD?

A P2Y12 inhibitor, such as clopidogrel or ticagrelor, might be a better choice than aspirin for antiplatelet monotherapy in patients with coronary artery disease, results of a new meta-analysis suggest.

The PANTHER meta-analysis showed that P2Y12 inhibitor treatment lowered the risk for subsequent ischemic events, particularly myocardial infarction (MI), compared with aspirin, without increasing bleeding risk.

The relative risk for the primary composite endpoint — cardiovascular death, MI, and stroke — was reduced by 12% in patients who received a P2Y12 inhibitor, compared with aspirin, primarily driven by a 23% relative reduction of MI. Stroke was also numerically but not significantly lower with P2Y12 inhibitor therapy.

The overall risk of major bleeding did not significantly differ, whereas gastrointestinal bleeding and hemorrhagic stroke occurred less frequently in patients who received a P2Y12 inhibitor rather than aspirin monotherapy.

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