Stopping Aspirin a Month After Stent Implant Helps Heart Patients

People who’ve survived a heart attack and have been given a stent may be better off quitting low-dose aspirin a month after the procedure, a new study finds.

The strategy is “beneficial by reducing major and minor bleeding through one year by more than 50 percent,” said study lead author Dr. Gregg Stone, a professor of medicine (cardiology) and population health science and policy at the Icahn School of Medicine at Mount Sinai, in New York City.

“Moreover, there was no increase in adverse ischemic [artery-blocking] events” when folks stopped using aspirin early, “meaning continuing aspirin was causing harm without providing any benefit,” Stone added.

His team presented its findings Sunday at the American College of Cardiology (ACC) annual meeting in Atlanta. The study was published simultaneously in The Lancet.

For folks who’ve had a heart attack or are at very high risk of experiencing one, low-dose daily aspirin is often given to cut their odds for blocked arteries.

However, long-term use of aspirin is also tied to another health danger: Bleeding.

So, the duration of aspirin use has long been up for debate.

In the new trial, outcomes were tracked for up to a year in over 3,400 heart patients treated at 58 centers in four countries. All the patients had undergone non-surgical, catheter-guided placement of a heart stent to open up a blocked artery.

At the beginning of the trial, all patients got a standard anti-clotting drug, ticagrelor (Brilinta), plus low-dose aspirin. But a month in, 1,700 patients had their aspirin replaced by a placebo pill, while the other half continued on the ticagrelor-aspirin dual therapy.

The result: Stopping use of aspirin appeared to cut the risk for bleeding by more than half (55%), Stone’s group found. They report that 35 cases of bleeding emerged among the group that stopped aspirin early, versus 78 cases among patients who carried on with the blood thinner.

What’s more, stopping aspirin didn’t raise patient’s odds for a clot or related cardiovascular “events” such as death, heart attack, stroke, bypass graft surgery, or the need for a new stent. These types of events occurred among 61 patients who quit aspirin early versus 63 cases among those who kept taking the drug, the researchers said.

So, “discontinuing aspirin in patients with a recent or threatened heart attack who are stable one month after [stent placement] is safe and, by decreasing serious bleeding, improves outcomes,” Stone said in an ACC news release.

Based on the new trial, he said that “it is my belief that it’s time to change the guidelines and standard clinical practice such that we no longer treat most [heart attack] patients with dual antiplatelet therapy” for more than a month after a stent is implanted.

Instead, “treating these high-risk patients with a single potent platelet inhibitor such as ticagrelor will improve prognosis,” Stone added.

More information

Find out more about treatments after a heart attack at the American Heart Association.

SOURCE: American College of Cardiology, news release, April 7, 2024