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Apr 22, 2016

Updated Guidelines for Dual Blood Thinners to Treat Heart Disease

New recommendations help reduce risk of complications and maximize benefits of treatment.

Key changes have been made to improve the safety and efficacy of dual blood thinner treatment in patients with heart disease, based on recent guidelines released by the American College of Cardiology and American Heart Association.

Published in both Circulation and the Journal of the American College of Cardiology, this paper updated existing guidelines around dual blood thinner use in patients with heart disease.

Many patients with heart disease are treated with two types of blood thinners—aspirin plus a second medicine that helps prevent blood clots. Dual treatment helps prevent complications and future heart events in patients with high cardiovascular risk. But like all medications, blood thinners can increase risk of complications like bleeding, which is why doctors continually update best practices to help minimize risk and maximize benefits of treatment.

What’s new in the latest guidelines? Based on 11 recent studies, experts made a few key changes for dual blood thinner treatment. These recommendations apply to many different patients, like those with heart disease or a history of heart attack, as well as patients who have undergone PCI (percutaneous coronary intervention) or CABG (coronary artery bypass graft).

Experts updated how long patients should be treated with dual blood thinners after a heart attack or having a stent put in. As experts explain, it’s always a careful balance between reducing risk of heart events while minimizing risk of bleeding—a common complication. Doctors have tried to identify the ideal amount of time that patients should be on such intensive treatment.

New recommendations have also been made regarding when it’s safe for patients on dual blood thinners to undergo surgery. Blood thinners are often stopped before surgery to prevent complications, so timing is important. For example, patients with stents often use aspirin plus a second blood thinner to prevent clots from forming around the device. If a patient needs surgery shortly after receiving a stent, careful planning is critical.

Ultimately, experts say that optimal blood thinner use depends on the characteristics of each patient. Patients at high risk of bleeding should generally be treated with blood thinners for a shorter duration to reduce risk of complications. Patients with very high risk for heart attack, however, may require more aggressive treatment for a longer period of time.

Read the full article in the Journal of the American College of Cardiology.

Questions for You to Consider

  • What is a blood thinner?
  • A blood thinner slows down the blood's ability to form clots. This helps prevent clots that can cause life-threatening problems such as stroke, heart attack and pulmonary embolism. These medicines also can keep blood clots from getting bigger. Blood thinner medicines work in different ways to prevent blood clots, but all of them raise the risk of serious bleeding.
  • How does aspirin help prevent heart attack and stroke?

  • Aspirin helps prevent heart attack and stroke by reducing blood clotting. Although blood clotting is the body’s natural way of healing damaged blood vessels, blood clots can travel to the heart and block major arteries, causing heart attack or stroke. Therefore, those at high risk for heart attack and stroke often take aspirin to help reduce clotting and risk for future cardiac events.


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