Researchers wanted to better understand the long-term risk of blockages, bleeding events and death among patients who received a cardiac stent. Here are five things to know about the new study recently published in JAMA Cardiology:
- A stent is a small, wire mesh tube (pictured below) that can strengthen a weak artery or open a narrow or blocked artery. Patients who have received a cardiac stent are at greater risk for blockages in blood flow to the heart or brain (called ischemic events) as a result of their heart disease or from clotting inside the stent. The use of aspirin combined with other similar drugs (called dual antiplatelet therapy) to prevent these incidents in the first year after receiving a stent has become standard practice. However, while dual antiplatelet therapy decreases risk of ischemic events, it also increases risk of fatal bleeding or bleeding in vital organs (called bleeding events) when continued longer than one year.
- This new study, led by Eric Secemsky, MD, MSc, a fellow in the Massachusetts General Hospital Division of Cardiology, looked at data from over 11,000 participants who underwent dual antiplatelet therapy for one year following the placement of a stent and had no ischemic or bleeding events. The participants were then randomized to either continue with the dual therapy for 18 months, or to receive aspirin plus placebo instead.
- Researchers found that taking both medications for a total of 30 months decreased ischemic risk (1.6% drop in ischemic events) while also increasing bleeding risk (0.9% increase in bleeding events). Overall, having either an ischemic or bleeding event severely increased risk of death – an 18-fold risk increase after any bleeding event and a 13-fold risk increase after any ischemic event.
- In a previous study, Secemsky developed a risk score that can help determine whether or not dual antiplatelet therapy should continue past the one-year mark. This tool, which is utilized by the American College of Cardiology, can help clinicians decide what treatment to prescribe. You can find it on the ACC website.
- With the understanding that both ischemic and bleeding events are associated with high risk of mortality, future efforts will focus on individualizing treatment and identifying patients who are likely to experience more benefit than harm from dual therapy.