For some cardiac patients with stents, long-term aspirin treatments might be on the way out

CNN
—

For some high-risk cardiovascular patients with stents, the often recommended long-term use of aspirin may not be effective and, in some cases, A new study finds that it’s even more harmful.

Reports published in scientific journals Circulationstudied more than 7,500 patients with acute coronary syndromes. Acute coronary syndrome is a term used to describe a variety of heart conditions, including heart attacks, caused by a sudden decrease in blood flow to the heart.

To treat this condition, each patient underwent a common procedure called percutaneous coronary intervention. In this procedure, your doctor screws small balloons into your body to widen blocked arteries. We also insert a metal mesh tube called “.” stent It flows into the coronary arteries and supports the blood vessels to keep blood flowing. To prevent blood clots from forming after stent insertion, most doctors recommend taking an antiplatelet drug along with aspirin for about a year.

However, this study found that removing aspirin from the regimen after 3 months was equally effective at avoiding clotting complications while significantly reducing the risk of severe bleeding that aspirin can cause. I discovered that.

“You often wonder, ‘What is aspirin doing next to an already very powerful drug?'” said the study’s principal investigator, a cardiologist at the Icahn School of Medicine at Mount Sinai. said Dr. Roxana Mehran. “What are we doing besides significantly increasing the risk of bleeding?”

Possibility of new standard treatment

Ccardiovascular disease According to the World Health Organization, they are the leading cause of death worldwide, killing approximately 18 million people each year.

For many years, medical professionals have widely recommended taking aspirin regularly to prevent heart disease because aspirin inhibits blood clotting and prevents complications such as heart attack and stroke.

However, this drug may also increase your risk of severe bleeding, especially as you get older.

As a result, in 2019, the American College of Cardiology and the American Heart Association reversed course. Daily aspirin is no longer recommended As a preventive measure for older people who are not at high risk or do not already have heart disease.And in 2022, the U.S. Preventive Services Task Force will recommended to the contrary Daily aspirin for people over 60.

For healthy young adults at high risk for heart attacks and strokes, taking aspirin daily may provide some benefit, but experts recommend weighing it against the risk of bleeding.

Still, many medical professionals believe that aspirin can be beneficial for many patients with heart disease or who have stents. But new research findings may cast doubt on that assumption.

We use pooled patient data from two large clinical trials. One we are helping run in the United States, and the other is a separate trial with collaborators in South Korea. — Researchers looked at patients with acute coronary syndrome who received ongoing treatment to prevent clotting after stent insertion.

Patients typically take aspirin and a strong anticoagulant called ticagrelor for up to a year after the stent is inserted. However, the report found that patients who stopped taking aspirin after three months had just as good outcomes as those who received combination therapy with aspirin and ticagrelor, with lower rates of death, heart attack, and stroke. The rates were the same in both groups.

Also, stopping aspirin reduced the risk of serious bleeding by nearly 50% compared to patients receiving the combination therapy, with no increased risk of cardiac complications, Mehran said.

Experts believe the discovery could lead to a new standard of care for patients with high-risk heart disease. Given the results of clinical trials and the growing body of evidence suggesting that long-term aspirin may not be beneficial in acute coronary syndromes, Mehran prescribes a long-term aspirin-free treatment plan for her patients. doing.

She also believes aspirin can be taken off sooner, possibly after a month. This shortened period is being investigated in several ongoing studies, she added.

“If there’s enough evidence that aspirin does little except increase bleeding during vulnerable periods, shouldn’t it be okay to stop taking aspirin after a certain period of time?” Mehran said. said.

Aspirin remains an ‘essential treatment’

But experts agree that aspirin remains Medicines beneficial for heart disease.

“The public should know that aspirin remains an important treatment for heart attacks, and in these studies, aspirin was an essential treatment for three months after stent insertion,” said Dr. said university professor Dr. Harlan Krumholz. M.D. wrote in an email to CNN.

First, this result does not apply to patients with other heart diseases. like Atrial fibrillation, a condition that requires blood thinners to treat.

“We’re not saying aspirin is terrible and should be stopped by all patients. That’s not the message at all,” Mehran added.

This report focuses on a select group of high-risk patients recovering from acute coronary syndromes and undergoing stenting, and the elimination of aspirin from the treatment plan is recommended for at least 1 year. Subject to patients taking ticagrelor.

Patients in the study also had to survive the first three months of combination therapy without complications before aspirin could be removed from their regimen.

Krumholz believes further research aimed at simplifying drug regimens could also improve patient health outcomes.

“We need more studies like this that test the value of stopping the drugs people are taking, rather than simply assuming they need to continue taking them,” he wrote. “This study helps us understand how to safely simplify medication regimens for these patients, so that subtracting drugs can actually improve outcomes.”