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HealthDay reporter
TUESDAY, Nov. 23, 2021 (HealthDay News) – People whose clogged arteries have reopened are likely to stop taking blood thinners sooner than previously thought, according to a new study.
Patients are regularly prescribed blood thinners for one year or more after angioplasty. This is done to ensure that blood does not clot in the metal stent that now keeps their artery open. This can cause a heart attack or stroke.
But heart doctors prescribe these blood thinners longer than necessary because the guidelines are based on data from clinical trials that are outdated, according to new findings.
“Our current guidelines may not apply to the average person in practice,” said lead researcher Dr. Neil Butala, a cardiologist at Massachusetts Hospital in Boston. “The average person receiving a stent today may be better off with shorter dual antiplatelet therapy” (which is aspirin plus a blood thinner).
The guidelines now call on most patients to take aspirin and a blood thinner for more than a year and up to 30 months to prevent blood clots from forming in their stent, Butala said.
But this guide is based on a clinical trial conducted about a decade ago. Piston and his fellow researchers suspected that improvements in stent technology may have changed the equation, making long-term blood thinners unnecessary for many.
Patients today are “more likely to receive a second-generation drug-eluting stent,” Butala said. Newer stents have a thinner structure and are coated with improved time-releasing drugs, both reducing the risk of clotting and therefore the need for blood thinners.
To test their theory, the researchers collected data from more than 8,800 patients who participated in the initial clinical trial. They compare them to more than 568,000 patients with similar heart problems today.
The researchers found that modern patients were indeed more likely to receive a second-generation stent and were also more likely to be treated for a heart attack than for chest pain.
These differences mean that patients are more likely to be harmed by long-term blood thinners than to help them, the new study concludes.
Patients taking long-term blood thinners are more than twice as likely to suffer from dangerous bleeding, but no longer receive significant benefits in reducing stent clotting or avoiding heart attack or stroke, the researchers said.
“In today’s population, we’ve actually found that the benefits are disappearing,” Butala said.
These results should prompt cardiac physicians to reconsider the length of time stent patients receive blood thinners, said Dr. Roxana Mehran, director of interventional cardiovascular research and clinical trials at Icahn Medical School in Mount Sinai, New York. . She did not participate in the new study.
“They show that the therapeutic effects of long-term blood thinners have limited applicability with the current practice of [angioplasty] and the types of devices we have available, “Mehran said.
“We really need to be aware of these blood thinners. You can’t just apply them as “Okay, you have to accept this for the rest of your life,” Mehran continued. “I think we need to individualize and talk to our patients, bring our patients into the equation, and make really shared decisions about the risk / benefit ratio for them.”
This does not mean that people should not take blood thinners at all; rather, they can only be admitted for three to six months after their stenting procedure, Butala said.
“Many recent studies of newer stents suggest that shorter dual antiplatelet therapy – even less than 12 months, such as six months or one month – is not actually shorter than longer duration,” said Butala. “All trials are moving towards shorter and shorter [dual antiplatelet therapy]”
And some patients may still need to take long-term blood thinners, Butala added. People are likely to take the medication longer if they have received a smaller stent, are smokers, or have health problems such as diabetes, previous heart attack, high blood pressure, congestive heart failure, or kidney disease.
Patients should talk to their doctor before making any changes to the prescribing regimen, Butala and Mehran said.
“It’s not like everyone stops taking all their medications because it’s dangerous,” Butala said. “They have to rely on their doctor to make sure their treatment is individualized and reflects the patient in front of them.”
The findings were published on November 16 in the journal Circulation.
More info
The Mayo Clinic has more information on angioplasty.
SOURCES: Neil Butala, Ph.D., Associate in Cardiology, Massachusetts General Hospital, Boston; Roxana Mehran, MD, Director, Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine in Mount Sinai, New York; Circulation, November 16, 2021
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