A Brazilian study showed that stopping using aspirin in the first months after a heart attack is not safe and may increase the risk of a second infarction, stroke and thrombosis. The survey was led by Einstein Hospital Israelita and is one of the highlights of the European Society of Cardiology (ESC) annual congress, which takes place in Madrid, Spain, and ends on Monday (1st).
Neo-Mindset research has followed 12 months more than 3,400 patients with acute coronary syndromes and assessed whether it would be safe to suspend the use of after stent angioplasty-a minimally invasive procedure used to clear arteries-, maintaining only an antiplatelet medicine (used to prevent blood clot formation).
“When one happens, there is the formation of fat signs in the arteries and sometimes the formation of clots, obstructing the passage of blood to the heart. Therefore, there is a need to immediately clear the artery to restore the flow of blood to that region,” explains Pedro Lemos, director of Cardiology of Einstein Israelite Hospital and senior author of research to research CNN.
“This can be done in a drug, with a medication that solve the clot, but the most efficient treatment is to clear the stent implant to allow the full passage of the blood,” he adds.
After the unobstruction of the artery with stent, it is necessary to prevent a new clot from forming in the heart region. For this, medications that thin blood are used, according to the expert. Currently, standard treatment after one infarction combines aspirin with another antiplatelet, a method called double platelet anti-giving. However, as aspirin can increase the risk of bleeding, there were doubts about its continuity.
Prior studies indicated that it is possible to remove aspirin after a few months, maintaining an initial period of double anti-giving. But it remained uncertain if the withdrawal could be performed shortly after the heart attack. Now, the results of Einstein research show that generally maintaining double medication from the outset is safer, reinforcing traditional protocol and influencing medical practices around the world.
What did the study show?
The researchers observed that early removal of aspirin – that is, soon after infarction – resulted in a significant reduction in bleeding, with a 2% incidence in the group that did not use the drug, compared to 4.9% in the group that maintained double therapy.
On the other hand, the change in the standard protocol did not maintain protection against severe cardiovascular events such as infarction, or urgent need for new revascularization. According to the study, the group they used without aspirin had a 7% higher risk of having these events, compared to 5.5% in the group that maintained the use.
In addition, the number of cases of stent thrombosis – a serious complication of this type of procedure, characterized by the formation of a blood clot in a coronary stent – seemed higher among patients who did not receive aspirin: 12 cases among those who did not use the drug, against 4 in the group that maintained use.
“What we have seen is that, in general, the removal of the aspirin early, right after the heart attack, is not as beneficial as leaving both medicines over the 12 months,” says Lemos. “One of the types of reinforce is stent thrombosis. So, in short: when we remove aspirin, we are not as protected as we give both medications,” he adds.
The work was carried out in partnership with the Ministry of Health, via Program to Support Institutional Development of the Unified Health System (Proadi-SUS) and involved 50 hospital centers from various regions of Brazil, with most participating patients being from the Unified Health System (SUS).
“The publication in the New England Journal of Medicine and the selection as a prominence in the main congress of cardiology around the world reinforces the maturity of clinical research conducted in Brazil. This is a relevant contribution to global medical practice, which projects Brazilian medology and medical science in an international scientific excellence,” says Luiz Vicente Rizzo, Einstein’s Executive Director of Research.
