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Replacing Aspirin with Prescription Blood Thinner Appears Safe after Heart Attack

CardioSmart News

Patients may want to consider a stronger combination of therapies to prevent future heart events, according to a recent study that safely replaced aspirin with a prescription blood thinner in heart attack survivors.

Published in The Lancet and recently presented at the American College of Cardiology’s Annual Scientific Session, this study tested the safety of rivaroxaban in patients with acute coronary syndrome.

Acute coronary syndrome, often referred to as ACS, occurs when blood flow to the heart is suddenly stopped. It includes heart attack and unstable angina, which is a type of unexpected chest pain that often occurs at rest. Both conditions increase risk for future events, which is why doctors recommend over-the-counter aspirin plus a prescription blood thinner to reduce risk of complications. However, experts wonder if a stronger combination of medication helps further reduce risk of heart events in patients with ACS.

To learn more, researchers randomly assigned 3,037 patients with ACS to aspirin or rivaroxaban, in addition to their standard medication. Standard medication included either clopidogrel or ticagrelor, which are a different class of blood thinners that help prevent heart attack and stroke.

After following patients for about a year, researchers found that bleeding events were similar among patients in either group. Bleeding is the most common risk associated with blood thinners and was the key outcome tracked in this study.

“This study is important because it is the first to show that replacing aspirin with a newer, more targeted drug—low-dose rivaroxaban, an anticoagulant—presents no additional risk of bleeding complications when given as dual therapy with an antiplatelet drug,” explains E. Magnus Ohman, MD, professor of medicine at Duke University Medical Center and lead author of the study. The trial was the first to test this new combination of therapy in patients with ACS, and experts are encouraged by findings.

However, authors note that studies are still needed to see whether this combination of blood thinners actually improves outcomes in patients with ACS. This trial showed that two different classes of blood thinners can be safely paired in patients with ACS. The next step, as experts explain, is to test whether the new combination helps reduce cardiovascular risk more than current treatment.

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