Study Finds No Benefit in Modulating Antiplatelet Therapy After Complex Stenting Procedures

Recent research presented at ESC Congress 2025 has shown that adjusting the intensity of antiplatelet therapy—either through early escalation or late de-escalation—does not improve outcomes in patients who have undergone complex coronary stenting procedures. The study, known as the TAILORED-CHIP trial, involved 2,018 high-risk patients across South Korea, comparing tailored antiplatelet strategies to standard therapy.

Typically, dual antiplatelet therapy (DAPT), consisting of aspirin plus a P2Y12 inhibitor like clopidogrel, is prescribed after percutaneous coronary intervention (PCI) to prevent ischemic events such as heart attacks. The rationale for the trial was that high-risk patients might benefit from a customized approach—using stronger inhibition early on to prevent ischemia, then weakening the regimen later to reduce bleeding risk.

In the trial, one group received a tailored approach: low-dose ticagrelor combined with aspirin for six months, followed by monotherapy with clopidogrel for another six months. The control group received the standard 12 months of clopidogrel plus aspirin. Results revealed no significant difference in the primary composite outcome of adverse events, which included death, heart attack, stroke, stent thrombosis, unplanned revascularization, or major bleeding, between the two groups after 12 months.

Interestingly, the tailored therapy group experienced a higher rate of clinically relevant bleeding (7.2%) compared to the standard therapy group (4.8%), while major bleeding rates were similar. Additionally, there was no notable reduction in ischemic events with the tailored approach.

Professor Duk-Woo Park from Seoul’s Asan Medical Center concluded that this study challenges the assumption that more aggressive or tailored antiplatelet strategies offer additional benefits in complex PCI patients. The findings support the continued use of standard 12-month DAPT for high-risk patients, as personalized approaches did not demonstrate clear net clinical advantages but did increase bleeding complications.

Overall, these results inform clinical decision-making, emphasizing that a more intensive or variable antiplatelet regimen does not necessarily translate to better outcomes in complex stenting cases.