It’s time to ditch aspirin.
A recent study suggests that a specific class of anti-clotting medications, known as P2Y12 inhibitors, may offer better long-term protection for heart patients with stents than the commonly prescribed low-dose aspirin. These medications, including clopidogrel and ticagrelor, were found to reduce the risk of major cardiovascular events such as heart attacks and strokes more effectively than aspirin, according to findings published in The BMJ.
The research showed that patients who took P2Y12 inhibitors after initial dual anti-clotting therapy had a 23% lower chance of experiencing cardiovascular death, a heart attack, or a stroke compared to those who continued on aspirin alone. On average, one serious heart-related event could be avoided for every 46 patients treated with a P2Y12 inhibitor instead of aspirin. These drugs work by targeting platelet receptors, decreasing the likelihood of clot formation, which is critical for patients with implanted stents.
Stents are commonly placed in patients to keep previously blocked or narrowed arteries open. Following stent placement, standard treatment involves a combination of aspirin and a P2Y12 inhibitor for a few months to prevent blood clots. Traditionally, patients then continue on aspirin alone for the long term. However, the new analysis indicates that extending treatment with P2Y12 inhibitors might be a safer and more effective strategy.
To reach these conclusions, researchers evaluated data from five separate clinical trials, involving over 16,000 participants with an average age of 65. After about four years of follow-up, those taking P2Y12 inhibitors experienced fewer heart attacks and strokes than those on aspirin, with no significant difference in major bleeding risks. Rates of overall death, stent-related complications, and heart-related deaths were similar between both treatment groups.
Despite the promising results, an editorial by researchers in the United Kingdom cautioned against immediately changing clinical practice. They pointed out that while clopidogrel is now off-patent, it remains costlier than aspirin. They emphasized the need for further long-term studies and cost-effectiveness analyses before P2Y12 inhibitors can be recommended as a replacement for aspirin in standard care.
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