New research indicates that patients may be able to stop taking aspirin soon after certain heart procedures without increased risk.
- Heart patients who undergo percutaneous
coronary interventions may no longer need to be on two blood thinners for
12 months afterward, according to a new study.
- Blood thinners are prescribed to avoid the
formation of clots after such procedures, but carry with them a risk of
bleeding events.
- The study found that participants who stopped
taking aspirin after one month — while continuing a second blood thinner
for 12 months — experienced a 55% reduction in bleeding issues with no
additional occurrence of cardiac events.
When someone receives a percutaneous coronary
intervention (PCI) to address a heart blockage, doctors prescribe a pair of
antiplatelet drugs — or blood thinners — for 12 months
post-procedure. A new study suggests that those blood
thinners may safely be cut in half after just one month.
The study
found that after a month of dual blood thinners, patients can safely stop
taking one without experiencing an increased risk of clots forming on the
hardware implanted during percutaneous coronary intervention.
The study is published in
Reducing the
risk of clots after heart procedures
While blood thinners
offer important protection against the formation of clots, they carry their own
risk: bleeding, an inability to form scabs over wounds, as well as other
adverse reactions.
The mix of post-procedure antiplatelet medications is referred to as
dual antiplatelet therapy or DAPT. It typically contains aspirin as well as a stronger P2Y12 receptor
inhibitor, of which there are several. The study involved the use of
ticagrelor.
DAPT is prescribed for 12 months because after that
period, there is less risk of clotting.
The study looked at medications and outcomes for 3,400
patients with acute coronary syndrome at 58 centers in
China, Italy, Pakistan, and the U.K., from August 2018 to October 2022.
All study participants had received PCI. They were
randomly assigned to one of two groups after being stable one month after the
procedure. For 1,700 patients, the new “DAPT” was simply ticagrelor and a
placebo. The remaining individuals remained on ticagrelor and aspirin for the
full 12 months.
Of the
participants in the ticagrelor-placebo group, just 35 had major or minor
bleeding events during the study, compared to 78 of the individuals taking
ticagrelor-aspirin after one month. This amounts to a 55% reduction in bleeding
events.
Major cardiovascular events were statistically similar
between the two groups, meaning that the cessation of aspirin in the
ticagrelor-placebo group did not result in an increase in adverse
cardiovascular outcomes.
What is percutaneous coronary intervention?
Cheng-Han Chen, MD, medical director of the
Structural Heart Program at the MemorialCare Heart & Vascular Institute at
Saddleback Medical Center in Laguna Hills, CA, who was not involved in the
study, told Medical
News Today:
“To fix the problem of clogged arteries, there are two
things you can do. In the old days, all we had was bypass
surgery, when a surgeon actually goes in and re-routes all the blood
supplies around the blockages.”
“[F]or the last 30 years we’ve had this thing called
percutaneous coronary intervention. It’s a minimally invasive procedure where
we thread small plastic tubes called catheters through either the groin or the
wrist up to the heart and then use wires, balloons, and
Blood clots forming around these wires, balloons, and
stents are the reason patients are prescribed DAPT. Such clots can block the
flow of blood, resulting in ischemic events.
Being so
much less invasive than bypass surgery, Chen said, “Percutaneous coronary
intervention is a very common technique now.”
“There’s percutaneous coronary interventions going on
every day at every single hospital,” said Chen.
The study addresses a balancing act with which
cardiologists have been grappling for some time. Jayne Morgan, MD, a cardiologist and the
Executive Director of Health and Community Education at the Piedmont Healthcare
Corporation in Atlanta, GA, who was also not involved in the study, described
the dilemma.
“Even though prevention of ischemic events is the
primary purpose of DAPT, there has been some debate regarding DAPT following
PCI in patients with both acute and chronic coronary syndromes, as the risk
benefit balance is weighed,” she told MNT.
“Clearly the risk of further ischemia must be
reduced,” she said. “On the other hand, at what price to increased bleeding and
its inherent morbidity on the patient as well?”
Morgan cited two studies, the PEGASUS_TIMI 54 and
Using 2 blood thinners after stenting
Morgan called the results compelling and said she was
looking forward to seeing more data on the topic.
“It appears that Single Action Platelet Therapy with
ticagrelor alone between months 1 and 12 resulted in a similar rate of MACCE
[major adverse cardiac and cerebrovascular events] with lower bleeding
complications,” she said.
“This study shows something that we were all
wondering. It actually shows that this strategy is effective, even though it’s
definitely a safer strategy than what we’re all doing now. And number two, it
showed that it wasn’t worse. It wasn’t causing more clots to form on the stent,
which is what you were giving the two blood thinners for. That’s really
important information for us,” said Chen.
Noting that giving two blood thinners after PCI has
been the strategy for decades, he said things will not change immediately.
However, the important advisory bodies, such as the American Heart Association,
American Cardiology College, and the Society for Cardiovascular Angiography
& Interventions revise their guidelines every few years.
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