Blood thinners after a stent may not be necessary

by Dennis Thompson
HealthDay Reporter

TUESDAY, NOVEMBER 23, 2021 (HealthDay News) – People who have had a clogged artery reopened are likely to stop taking blood-thinning medication faster than previously thought, a new study claims.

Patients are regularly prescribed blood thinners for a year or more after angioplasty. This is to ensure that the blood does not clot inside the metal stent that now holds their artery open. It can cause a heart attack or stroke.

But cardiologists prescribe these blood thinners longer than necessary because guidelines are based on data from outdated clinical trials, according to new findings.

“Our current guidelines may not apply to the average person in practice,” said lead researcher Dr. Neel Butala, a cardiology fellow at Massachusetts General Hospital in Boston. “The average person today who receives a stent may be better off with shorter double antiplatelet therapy” (which is aspirin plus a blood thinner).

Guidelines now encourage most patients to take aspirin and blood thinners for more than a year and as long as 30 months to prevent blood clots from forming in their stent, Butala said.

But that guidance is based on a single clinical trial that took place about a decade ago. Butala and his co-researchers suspected that improvements in stent technology were likely to change 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. The newer stents have a thinner structure and are coated with improved time-release drugs, both of which reduce the risk of coagulation and thus the need for blood-thinning drugs.

To test their theory, the researchers collected data from more than 8,800 patients who participated in the initial clinical trial. They compared them to more than 568,000 contemporary patients with similar heart problems.

The researchers found that modern patients were actually more likely to receive a second-generation stent, and that they were also more likely to receive treatment for a heart attack compared to chest pain.

These differences mean that patients are more likely to be harmed by long-term blood thinners than helped, the new study concluded.

Patients on long-term blood thinners are more than twice as likely to suffer from dangerous bleeding, but they no longer receive any significant benefit from reducing coagulation in the stent or avoiding a heart attack or stroke, researchers said.

“In a contemporary population, we actually found that the benefit disappears,” Butala said.

These findings should prompt cardiologists to reconsider how long stent patients are taking blood-thinning medications, said Dr. Roxana Mehran, director of interventional cardiovascular research and clinical trials at the Icahn School of Medicine at Mount Sinai in New York City. She was not involved in the new investigation.

“They show that the therapeutic effects of long-term blood thinners have limited applicability to current practice of [angioplasty] and the kind of devices we have available to us, “Mehran said.

“We really need to be aware of these blood thinners. You can not just use them like, ‘OK, you have to take 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 joint decisions about the risk-benefit relationship for them.”

This is not to say that people should not take blood thinners at all; rather, they can only take them for three to six months after their stenting procedure, Butala said.

“Many of the more recent trials of newer stents suggest that shorter durations of dual antithrombocyte therapy – even less than 12 months, such as six months or a month – are actually no less than longer durations,” Butala said. “All the experiments have moved in the direction of shorter and shorter and shorter [dual antiplatelet therapy]. “

And some patients may still need to take long-term blood thinners, Butala added. People should probably take the medicine longer if they have had a minor stent, are smokers or have health problems such as diabetes, previous heart attacks, high blood pressure, congestive heart failure or kidney disease.

Patients should talk to their doctor before changing their prescription, Butala and Mehran said.

“It’s not like everyone has to stop taking all their medicine, because it’s dangerous,” Butala said. “They should trust that their doctor makes sure that their treatment is individualized and reflects the patient in front of them.”

The results were published Nov. 16 in the journal Circulation.

More information

The Mayo Clinic has more on angioplasty.

SOURCES: Neel Butala, MD, Cardiology Fellow, Massachusetts General Hospital, Boston; Roxana Mehran, MD, Director, Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York City; CirculationNovember 16, 2021

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