Possible alternative title: Potential Shift in Long-Term Aspirin Treatment for Certain Cardiac Patients with Stents
New study suggests prolonged use of aspirin may be ineffective and even harmful for high-risk cardiovascular patients with stents, potentially altering the standard of care Aspirin remains essential, but its long-term benefits are being questioned (346 characters)
Taking aspirin for an extended period of time may not be effective, and could possibly be harmful, for certain high-risk cardiovascular patients with stents, according to a recent study published in the scientific journal Circulation. The study examined over 7,500 patients with acute coronary syndrome, which encompasses a range of heart conditions, including heart attacks, caused by a sudden decrease in blood flow to the heart.
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In order to treat the condition, all patients underwent percutaneous coronary intervention, a common procedure involving the insertion of a small balloon to open the blocked artery. Additionally, a metallic mesh tube called a stent was inserted into the coronary artery to support blood flow. To prevent blood clots from forming after the stent placement, doctors commonly recommend a combination of an antiplatelet medication and aspirin for approximately one year.
However, the study discovered that eliminating aspirin from the medication regimen after three months achieved the same effectiveness in preventing clotting complications while significantly reducing the risk of severe bleeding that aspirin can cause.
Potential for new standard of care
"You often ponder the purpose of aspirin being in proximity to such a highly potent agent," stated Dr. Roxana Mehran, the lead researcher of the study and a cardiologist at the Icahn School of Medicine at Mount Sinai. "Besides drastically heightening the risk of bleeding, what other significant role does it serve?"
According to the World Health Organization, cardiovascular diseases, which account for nearly 18 million deaths annually, are the primary cause of death globally.
Traditionally, medical experts have extensively advocated the regular use of aspirin to mitigate heart issues, as it aids in reducing blood clot formation, thus preventing complications such as heart attacks and strokes.
However, the medication could also increase the risk of severe bleeding, particularly as people get older.
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Consequently, the American College of Cardiology and the American Heart Association altered their stance in 2019 and discontinued the recommendation of daily aspirin for older adults with no significant risk or existing heart disease as a preventive measure. Additionally, the United States Preventive Services Task Force advocated against daily aspirin intake for individuals over 60, as per their 2022 recommendation.
Daily aspirin may provide a slight advantage for otherwise healthy younger adults who face an elevated risk of heart attack or stroke. However, experts advise careful consideration of potential bleeding risks before making a decision.
Nevertheless, it is common for healthcare professionals to believe in the benefits of aspirin for individuals with heart issues or those who have undergone stent procedures. Nonetheless, the findings of the recent study may question this assumption.
The researchers utilized combined patient data from two extensive clinical trials—one conducted by Mehran in the United States and another conducted by collaborators in South Korea. They focused on patients with acute coronary syndrome who were on ongoing clot-prevention therapy after receiving stents.
Typically, patients receive a combination of aspirin and a potent anti-clotting medication, ticagrelor, for up to a year after receiving the stent. However, according to the report, patients who discontinued aspirin after three months had similar outcomes to those on the combination therapy of aspirin and ticagrelor. Both groups showed similar rates of death, heart attacks, and strokes.
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Mehran found that eliminating aspirin from the combination therapy reduced the likelihood of severe bleeding by almost 50%, without raising the risk of cardiac complications. This discovery has the potential to establish a new standard of care for cardiac patients at high risk. Based on the results of her clinical trial and accumulating evidence that long-term aspirin may not offer significant benefits for acute coronary syndrome, Mehran now recommends a treatment regimen that excludes long-term aspirin for her own patients.
Mehran suggests that aspirin can potentially be discontinued from the treatment plan even sooner, possibly within a month. Ongoing studies are currently examining this shortened timeline, according to her.
Mehran stated, "If we obtain substantial evidence indicating that aspirin does not have significant benefits apart from causing increased bleeding during that susceptible period, then why not halt its usage after a specific duration?"
Aspirin remains an essential therapy
However, experts agree that aspirin remains a beneficial medication for heart conditions.
Dr. Harlan Krumholz, a cardiologist and professor at the Yale School of Medicine, emphasized the significance of aspirin as a crucial treatment for a heart attack. According to him, it remains an essential therapy in the three months following the stent procedure. However, it is important to note that these study results are not applicable to patients with other heart conditions like atrial fibrillation, which necessitate the use of blood thinners.
Mehran clarified that the intention is not to imply that aspirin should be completely discontinued in all patients - that is not the intended message. The study centered on a specific subset of high-risk patients who were recuperating from acute coronary syndrome and had a stent placed. The decision to exclude aspirin from their treatment regimen is contingent upon these patients adhering to a twice-daily dosage of ticagrelor for a minimum duration of one year.
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Patients in the study were required to successfully complete the initial three-month period of combination therapy without experiencing any complications prior to discontinuing aspirin from their treatment regimen. Krumholz asserts that conducting additional research aimed at streamlining medication plans could enhance patients' overall health.
This study highlights the importance of conducting more studies that examine the potential benefits of discontinuing medications, rather than blindly assuming their necessity. By exploring the value of withdrawing certain drugs, we can better comprehend ways in which we can safely simplify drug regimens for patients and potentially enhance their outcomes.
