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The Glow Finish

What this trial gets right (and why it matters): Not just long-term very long-term randomized data (a rarity in antiplatelet trials) A clinically honest question at a real decision point (post-DAPT monotherapy) Captures both sides of the equation: ischemia and bleeding Suggests a durable signal favoring clopidogrel not an early divergence that attenuates Nuances that are easy to miss: This is a survivor cohort patients who tolerated and completed DAPT uneventfully It is less about what to start and more about what to continue The bleeding signal is important because it challenges a long-standing cognitive bias regarding aspirin safety The benefit is incremental, not transformative but over 10 years, small differences accumulate Limitations (still very real): East Asian population different ischemic and bleeding risk balance Open-label design No pharmacogenomic stratification (CYP2C19 variability) Real-world questions this actually raises: Are we continuing aspirin because it is best or because it is familiar