2023-11-02 09:47:15
Dubai, United Arab Emirates (CNN) – A new study has found that for some at-risk cardiovascular patients who use stents, the often recommended practice of taking aspirin for long periods may be ineffective and, in some cases, harmful.
The report, published in the scientific journal Circulation, reviewed data on more than 7,500 patients with acute coronary syndrome, a term that describes a variety of heart diseases, including heart attacks, caused by a sudden reduction in blood flow to the heart.
To treat this condition, each patient underwent a common procedure called percutaneous coronary intervention, in which doctors insert a small balloon inside the body to open the blocked artery. They also insert a metal mesh tube called a stent into the coronary artery that supports the blood vessels and maintains blood flow. To prevent blood clots following stent placement, most doctors recommend taking a combination of antiplatelet medications and aspirin for regarding a year.
But the study found that eliminating aspirin following three months is equally effective in avoiding clotting complications, while significantly reducing the risk of severe bleeding that aspirin can cause.
“We often think, ‘What does aspirin really do other than dramatically increase the risk of bleeding?'” said Dr. Roxana Mehran, the study’s lead researcher and a cardiologist at the Icahn School of Medicine at Mount Sinai.
Possibility of setting new standards of care
According to the World Health Organization, cardiovascular diseases are the leading cause of death worldwide, responsible for regarding 18 million deaths annually.
For years, medical professionals have widely recommended taking aspirin regularly to prevent heart problems, because aspirin may reduce blood clotting to prevent complications such as heart attacks or strokes.
However, this medication can also increase the risk of severe bleeding, especially as people get older.
As a result, in 2019, the American College of Cardiology and the American Heart Association changed course. It no longer recommends daily aspirin as a preventive measure for older adults who do not have high-risk or existing heart disease. In 2022, the US Preventive Services Task Force recommended that people over 60 should not take daily aspirin.
For healthy and younger adults with an increased risk of heart attack or stroke, daily aspirin can have a modest benefit.
However, there are still many healthcare professionals who consider aspirin beneficial for many patients who have heart problems or have a stent. But the results of the new study may challenge this assumption.
Using pooled patient data from two large clinical trials, one that Mehran helped conduct in the United States and a separate one from collaborators in South Korea, the researchers looked at patients with acute coronary syndrome who were receiving ongoing anticoagulation therapy following stent placement.
Typically, patients take a combination of aspirin and a powerful anticoagulant medication called ticagrelor, for a year following the stent is inserted. However, the report found that patients who stopped taking aspirin following three months were as well as those who took the combination treatment of aspirin and ticagrelor: rates of death, heart attacks, and strokes were the same in both groups.
Mehran said omitting aspirin also reduces the risk of severe bleeding by approximately 50% compared to patients receiving the combination therapy, without increasing the risk of heart complications.
This is a finding that experts believe might lead to a new standard of care for at-risk heart patients. Given the results of her clinical trial and the growing body of evidence suggesting that long-term aspirin may not be beneficial for acute coronary syndrome, Mehran prescribes a long-term non-aspirin treatment plan for her patients.
She also believes aspirin might be removed from the regimen even earlier, perhaps following a month. She added that this short time frame is being investigated through several ongoing studies.
Mehran continued: “If we have good evidence that aspirin does nothing but increase bleeding in that vulnerable period, why don’t we withdraw aspirin following a certain period of time?”
Aspirin remains an “essential treatment”
However, experts agree that aspirin remains a useful drug for heart disease.
According to Dr. Harlan Krumholz, a cardiologist and professor at Yale School of Cardiology, “The public should know that aspirin remains an important treatment for a heart attack, and in these studies, it was a mainstay treatment in the three months following stent placement.”
The findings do not apply to patients with other heart problems, such as atrial fibrillation, a condition that requires treatment with blood thinners.
Mahran pointed out, “We are not saying that aspirin is harmful and should be stopped for all patients. This is not the message at all.”
The report focused on a select group of high-risk patients recovering from acute coronary syndrome and stent placement, and excludes aspirin from treatment plans for patients taking ticagrelor twice daily for a minimum of one year.
Krumholz believes more research aimed at simplifying medication plans might also improve patients’ health.
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