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Doctor, I am taking an anticoagulant and just had a cardiac stent inserted. How long do I need to take three blood thinners?

This study shows that it may be safe for some people who have a cardiac stent inserted to take 3 blood thinners for as short as 1 month. However, your cardiologist is the best person to tell you what is best for you.


Study highlights

Patients taking an anticoagulant plus a short course of antiplatelet therapy after insertion of a cardiac stent did not have more blockages of their stents with blood clot than patients taking an anticoagulant plus a longer course of antiplatelet therapy.

Some patients have a cardiac stent inserted into the blood vessels that supply blood to their heart (coronary arteries) because they are blocked with blood clot. After the stent is inserted, there is a concern that the stent may also become blocked by a blood clot and cause a heart attack. Antiplatelet medications make it harder for blood to clot and studies have shown that taking two antiplatelet medications, such as aspirin and clopidogrel, at the same time, reduces the risk of a blood clot forming within a stent.

Many people who have a stent also need to take a different type of blood thinner called an anticoagulant to prevent stroke due to atrial fibrillation, prevent blockage of a mechanical heart valve or to treat a DVT or PE. Unfortunately, anticoagulants alone do not prevent blood clots forming within cardiac stents.

Bleeding is the main side effect of both antiplatelet medications and anticoagulants. Taking an anticoagulant plus antiplatelet medications at the same time (total of 3 blood-thinning medications) increases the risk of bleeding more than taking either type of medication alone. The standard length of time that patients with a new stent are asked to take 3 blood thinners is 3 months and then after that, they take one antiplatelet medication with their anticoagulant (total of 2 blood-thinning medications) for 1 year.

Investigators wanted to know if a shorter course of taking 3 blood thinners (anticoagulant plus two antiplatelet medications) would reduce the risk of bleeding without increasing the risk of stents becoming blocked with blood clot.


Who? The study included 1,666 people who had a cardiac stent inserted while being treated with an oral anticoagulant.

What? The study compared short-term antiplatelet therapy with longer term antiplatelet therapy.

Short-Term Antiplatelet Therapy

vs

Longer Term Antiplatelet Therapy

Continued use of an oral anticoagulant

AND

Use of 2 antiplatelet medications for 1 month (total of 3 blood thinners) followed by 5 more months of a single antiplatelet medication (total of 2 blood thinners)


Continued use of an oral anticoagulant

AND

Use of 2 antiplatelet medications for 3 months (total of 3 blood thinners) followed by 9 more months of a single antiplatelet medication (total of 2 blood thinners)

Short-term antiplatelet therapy vs longer term antiplatelet therapy in people who are already taking an anticoagulant medication after insertion of a cardiac stent

Outcomes at 12 months

Rate of events with Short-Term Antiplatelet Therapy

Rate of events with Longer Term Antiplatelet Therapy

Results

Ischemic Events (death, heart attack, stroke)

About 6 out of 100 people

About 7 out of 100 people

No effect*

Bleeding

About 10 out of 100 people

About 12 out of 100 people

No effect*

*Although the rates for the 2 groups look different, the differences were not statistically significant—this means that the difference could simply be due to chance rather than due to the different treatments.

This Evidence Summary is based on the following article:

Smits PC, Frigoli E, Tijssen J, et al. Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk With or Without Oral Anticoagulant Therapy After Coronary Stenting: An Open-Label, Randomized, Controlled Trial. Circulation. 2021 Oct 12;144(15):1196-1211. doi: 10.1161/CIRCULATIONAHA.121.056680. Epub 2021 Aug 29. PubMed

Published: Wednesday, November 2, 2022


Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.