Aspirin Versus Clopidogrel in Chronic Coronary Syndrome in Arabian Gulf Countries

Inclusion criteria

• Age ≥18 years.
• Significant coronary artery disease (coronary angiogram documentation of Left Main artery lesion ≥50% and/or lesion(s) ≥70% in other coronary arteries, and/or FFR<0.8 or iFR<0.9).
• Completed at least 6 months post ACS (regardless of the bleeding risk, anti-platelet strategy, revascularization strategy "PCI, CABG, or conservative medical management only", before randomization).
• Agreement to give written informed consent.

Exclusion criteria

• History of hypersensitivity to aspirin or clopidogrel.
• Presence of non-cardiac comorbidity with life expectancy ≤2 years from randomization.
• Plan for surgery or intervention which requires stopping antiplatelet agents ≥3 months.
• Females with childbearing potential or breast-feeding.
• Co-administration of contraindicated medications as follows: anticoagulants (warfarin, direct oral anticoagulants (DOACs), or chronic therapy of heparin); cytochrome P450 2C19 inhibitors (fluoxetine, moclobemid or voriconazole); probenecid; high dose of methotrexate (≥15 mg/week); lithium.
• Inability to have a complete follow-up for up to 5 years from randomization (e.g: high possibility of travelling outside the country).
• Inability to afford paying for Clopidogrel out-of-pocket up to 5 years from randomization (in case not being covered by the health care system).