Two blood thinners are better than one when it comes to preventing a second heart attack, according to research presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.
Known as the PEGAGUS-TIMI 54 trial, this study tested the efficacy of adding a blood thinner called ticagrelor to a daily aspirin regimen for preventing a second heart event. While many heart attack patients take low-dose aspirin to reduce risk of a future heart attack or stroke, it’s unclear whether adding a second blood thinner is safe and effective. Like all drugs, blood thinners increase risk of certain complications, and it’s important to ensure that the benefits of such therapy outweigh potential risks.
To learn more, researchers randomly assigned more than 21,000 heart attack survivors already taking aspirin to one of three groups. The first two groups took daily aspirin plus 60 mg or 90 mg of ticagrelor twice daily, while the third group took aspirin plus an inactive placebo drug.
After following patients for nearly three years, researchers found that those taking ticagrelor had 15–16% lower risk of a second heart event than those taking the inactive drug. However, ticagrelor significantly increased risk of major bleeding compared to aspirin alone.
The good news, as authors explain, is that adding ticagrelor to low-dose aspirin may significantly reduce risk of a second heart event. It’s estimated that 735,000 Americans suffer a heart attack each year and helping heart attack survivors prevent a second event has the potential to save millions of lives. While this study only followed patients for three years, researchers believe that the longer patients take the combined therapy, the greater the benefits will be.
However, given the increased bleeding risk associated with ticagrelor, doctors should use caution when prescribing dual blood thinners to patients with a history of heart attack. Certain individuals are at greater risk of bleeding, and combined therapy may not be safe for such patients. The lower dose of ticagrelor was also associated with lower risk of bleeding, so lower doses should be used when appropriate to reduce risk of complications.
With future research on the topic, experts hope to better understand the risks and benefits associated with dual blood thinners to help heart attack patients safely and effectively reduce their risk of a second event.