Heart Stents and Medication
Recent study
The accepted treatments
I have always wondered about the practice common in today’s medical practice where all patients are prescribed exactly the same medications after the fitting of stents, and in particular the prescribing of aspirin and ibuprofen in the quest to prevent blood clotting post operation.
In my past studies, the benefits of some of these chemicals have been called into question, and mostly the efficacy of aspirin.
A recent study looked into the common practice of delaying the use of headache medicine for some high-risk cardiovascular patients with stents, and the study found that this practice might not be effective, and could even be harmful in some cases.
The study involved over 7,500 patients with acute coronary syndrome, a term that refers to various heart conditions, including heart attacks, caused by a sudden decrease in blood flow to the heart.
These patients underwent a procedure called percutaneous coronary intervention, where a small balloon is used to open blocked arteries, and a mesh tube called a stent is placed in the artery to keep it open.
To prevent blood clots after stent placement, doctors typically recommend a combination of an antiplatelet (anti-clotting) medication and aspirin for about a year.
However, the study found that stopping aspirin after three months was just as effective in preventing clotting complications, while significantly reducing the risk of serious bleeding that aspirin can cause. This finding challenges the traditional belief that aspirin should be continued for a longer period in patients with heart problems or stents.
The pros and cons
Cardiovascular diseases are a leading cause of death worldwide, responsible for nearly 18 million deaths each year, and while aspirin was previously widely recommended to prevent heart issues, it can increase the risk of severe bleeding, especially in older individuals. Recent guidelines have shifted away from daily aspirin for older adults who do not have a high risk of heart disease.
However, some healthcare professionals still consider aspirin beneficial for certain heart patients. The study’s results suggest that aspirin may not need to be continued for a year after stent placement and could be safely discontinued after three months, potentially even sooner.
This finding could lead to a new standard of care for high-risk heart patients.
While aspirin remains an important treatment for heart attacks, the study focused on a specific group of patients recovering from acute coronary syndrome and stent placement. The decision to discontinue aspirin from their treatment plans depends on patients taking another medication called Ticagrelor for almost a year.
Overall, this research highlights the importance of re-evaluating medication regimens for specific patient groups and potentially improving patient outcomes by carefully adjusting their treatment plans.
Citations:
Safety and Efficacy of Ticagrelor Monotherapy in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: an Individual Patient Data Meta-analysis of TWILIGHT and TICO Randomized Trials
Usman Baber, Yangsoo Jang, Angelo Oliva, Davide Cao, Birgit Vogel, George Dangas, Samantha Sartori, Alessandro Spirito, Kenneth F. Smith, Mattia Branca, Timothy Collier, Stuart Pocock, … See all authors
Originally published23 Oct 2023https://doi.org/10.1161/CIRCULATIONAHA.123.067283Circulation. 2023;0
