Antiplatelet Therapy for Secondary Prevention: What Works Best as Monotherapy?

Antiplatelet therapy is recommended for all patients with established atherosclerosis, although the optimal agent for risk reduction has not been established. Aspirin has traditionally been used in secondary prevention, but the availability of P2Y₁₂ inhibitors raises the question: Is aspirin or P2Y₁₂ inhibitor monotherapy associated with greater risk reduction in secondary prevention? These investigators performed a systematic review and meta-analysis of all nine randomized head-to-head trials comparing monotherapy with P2Y₁₂ inhibitor or with aspirin for secondary prevention of atherosclerotic cardiovascular disease; the studies included a total of 42,108 patients.

Patients randomized to a P2Y₁₂ inhibitor had a statistically significant red…