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Heart patients who get a stent to prop open a blocked artery are typically put on a powerful anti-clotting drug and aspirin for a full year after their procedure.
Now, new research suggests these patients can safely drop the aspirin regimen after just three months, and lower their bleeding risk in the process.
Regimen suggested for six months
"Even though this treatment strategy needs to be confirmed in other trials, aspirin may be discontinued in most patients receiving current-generation drug-eluting stents, especially in patients with bleeding risk or in those with stable ischaemic heart disease," said lead author Dr Joo-Yong Hahn. He's a professor of medicine at Sungkyunkwan University School of Medicine in Seoul, South Korea.
Current guidelines recommend prescribing aspirin and a P2Y12 inhibitor – such as Plavix (clopidogrel), Effient (prasugrel) or Brilinta (ticagrelor) – for at least 12 months for patients who receive a stent after a heart attack. That regimen is suggested for six months among patients receiving a stent for angina.
This study examined whether stopping aspirin after three months but continuing the P2Y12 inhibitor alone for 12 months would reduce the risk of bleeding without increasing clotting risk.
The trial included nearly 3 000 patients in South Korea who received a drug-eluting stent, which releases drugs to prevent new blockages. The patients were randomly selected to receive either both drugs for a year or both drugs for three months and dropping aspirin after that.
Reducing risk of bleeding
After one year, the death rate from heart attack, stroke or any cause was 2.9% among patients who stopped aspirin early and 2.5% among those who didn't, according to the researchers.
In addition, stopping aspirin early reduced the risk of bleeding by about 40%, the findings showed. Rates of major bleeding were 2% among those who stopped aspirin early and 3.4% among those taking both drugs for a year.
Overall, there was no significant difference in rates of death or bleeding between the two groups, according to the study authors. The research was presented at the American College of Cardiology's annual meeting, in New Orleans. Such research is considered preliminary until published in a peer-reviewed journal.
The study received funding from Abbott Vascular, Biotronik and Boston Scientific, the researchers said in a meeting news release.
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