A recent study by the Cardiocentro Ticino Foundation suggests that P2Y12 inhibitors may lower the risk of heart attacks and strokes in people with coronary artery disease more effectively than aspirin, without increasing the risk of major bleeding.
Aspirin is widely used as a long-term treatment to prevent heart problems in patients with blood vessel disease.
For people with acute coronary syndrome, the current standard of care involves a combination of aspirin and a P2Y12 inhibitor (known as dual antiplatelet therapy or DAPT) for a period of time, followed by lifelong aspirin therapy. Previous research has also shown that clopidogrel, one of the P2Y12 inhibitors, slightly reduces heart-related events compared to aspirin.
In this study, researchers evaluated the effects of P2Y12 inhibitors (clopidogrel, prasugrel, or ticagrelor) compared to aspirin in patients with established coronary artery disease.
The study included 24,325 participants, with 12,178 receiving P2Y12 inhibitors and 12,147 taking aspirin. Participants had an average age of 64.3 years, and 21.7% were women. The treatments were followed for an average of 557 days.
The findings showed that P2Y12 inhibitors were more effective than aspirin in reducing the risk of heart attacks and strokes. Patients on P2Y12 inhibitors experienced a 12% lower overall risk of these events, with a significant 23% relative reduction in heart attack risk.
Importantly, this improved protection did not come with an increased risk of major bleeding. In fact, patients on P2Y12 inhibitors had fewer cases of gastrointestinal bleeding and hemorrhagic strokes compared to those taking aspirin.
The results indicate that P2Y12 inhibitors could be a safer and more effective option than aspirin alone for long-term prevention of heart problems in patients with coronary artery disease.
Professor Marco Valgimigli, who led the study, highlights the potential of P2Y12 inhibitors to provide better outcomes without compromising safety.
This research may lead to a reconsideration of standard treatment guidelines for coronary artery disease, offering hope for improved prevention strategies in high-risk patients.
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