(CNN) -- For some high-risk cardiovascular patients with stents, the commonly recommended practice of taking aspirin for long periods of time may be ineffective and in some cases even harmful, a new study shows.
The report, published in the journal Circulation , examined more than 7,500 patients with acute coronary syndrome: a term that describes various heart diseases, including heart attacks, caused by a sudden drop in blood flow to the heart.
To treat the disease, each of the patients underwent a common procedure called percutaneous coronary intervention, in which doctors insert a small balloon into the body to open the blocked artery. They also insert a metal mesh tube , called a stent, into the coronary artery, which supports the blood vessel and maintains blood flow. To prevent blood clots after stent placement, most doctors recommend taking a combination of an antiplatelet drug and aspirin for about a year.
However, the study found that eliminating aspirin from the diet after three months was just as effective in preventing clotting complications while significantly reducing the risk of serious bleeding that aspirin can cause.
"People often ask themselves, 'What does aspirin do next to a very, very strong active ingredient?' "," said Dr. Roxana Mehran, principal investigator of the study and a cardiologist at the Icahn School of Medicine at Mount Sinai. "What does it do other than significantly increase the risk of bleeding?
Potential for a new standard of care
Cardiovascular disease is the leading cause of death worldwide, accounting for nearly 18 million deaths each year, according to the World Health Organization.
For years, doctors have regularly recommended aspirin to prevent heart problems, as aspirin can reduce blood clotting and prevent complications such as heart attack or stroke.
However, the drug could also increase the risk of serious bleeding, especially as people age.
As a result, in 2019, the American College of Cardiology and the American Heart Association changed course and no longer recommend daily aspirin as a preventive measure for older adults who are not at high risk or who do not have existing heart disease. And in 2022 , the US Preventive Services Task Force recommended that people over 60 should not take aspirin daily .
For young, healthy adults at higher risk of heart attack or stroke, taking aspirin daily may have a modest benefit, although experts still recommend weighing this against the risk of bleeding.
However, many health experts still consider aspirin to be helpful for many patients with heart problems or stents. However, the results of the new study may challenge this hypothesis.
Using pooled patient data from two large clinical trials (one that Mehran helped lead in the United States and a separate study led by collaborators in South Korea), the researchers studied patients with acute coronary syndrome who had an acute coronary syndrome after stent implantation received ongoing treatment to prevent blood clots.
Typically, patients take a combination of aspirin and a powerful blood-thinning medication called ticagrelor for up to a year after stent placement. However, the report found that patients who stopped taking aspirin after three months fared just as well as those who took the combination therapy of aspirin and ticagrelor: Mortality, heart attack and stroke rates were the same in both groups .
Stopping aspirin also reduced the risk of serious bleeding by nearly 50% compared to patients who received combination therapy, Mehran said, without increasing the risk of cardiac complications.
Experts say the discovery could lead to a new standard of care for high-risk heart patients. Given the results of his clinical trial and a growing body of evidence suggesting that long-term use of aspirin may not provide benefit for acute coronary syndrome, Mehran prescribes a long-term aspirin-free treatment plan to his own patients.
He also believes that aspirin can be eliminated from the diet even sooner, perhaps after a month. This shortening of the deadline is the subject of several ongoing studies, he added.
"If we have good evidence that aspirin doesn't do much except increase bleeding in this vulnerable period, then why not stop taking the aspirin after a while?" » said Mehran.
Aspirin remains "an essential therapy"
However, experts agree that aspirin is still an effective medication for heart disease.
"The public needs to know that aspirin remains an important treatment for heart attacks and that in these studies it was an essential treatment within three months of receiving the stent," said Dr. Harlan Krumholz, cardiologist and professor at Yale School of Medicine. Medicine, he wrote in an email to CNN.
For one thing, the results don't apply to patients with other heart problems like atrial fibrillation, a condition that requires treatment with blood thinners.
"We are not saying that aspirin is terrible and should be stopped in all patients; That's not the message at all," Mehran added.
The report focused on a select group of high-risk patients recovering from acute coronary syndrome and stent implantation. Removal of aspirin from their treatment plans depends on patients taking ticagrelor twice daily for at least a year.
Patients in the study also had to complete the first three months of combination therapy without complications before aspirin was removed from their regimen.
Krumholz believes more research to make taking medications easier could also improve patient health.
"We need more studies like this where we test the benefits of stopping medications rather than just assuming we should continue them," he wrote. "This study helps us understand how we can safely simplify the medication regimen for these patients and improve outcomes by eliminating a medication." »
The CNN Wire
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