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Giving a P2Y12 inhibitor anti-clotting drug to sufferers with coronary artery illness is related to decrease charges of cardiovascular demise, coronary heart assault and stroke in contrast with conventional aspirin, with no elevated threat of main bleeding, finds a research revealed by The BMJ.
P2Y12 inhibitors are sometimes given to sufferers alongside aspirin (“dual therapy”) after percutaneous coronary intervention (PCI)—a process to widen or unblock a coronary artery—to assist stop cardiovascular occasions together with coronary heart assault and stroke.
After a number of months, sufferers are normally switched from twin remedy to lifelong aspirin, however some trials have recommended {that a} P2Y12 inhibitor could also be simpler for long-term prevention than aspirin.
To discover this additional, researchers analyzed particular person affected person information from 5 randomized medical trials involving 16,117 sufferers (common age 65; 24% ladies) who have been assigned to a P2Y12 inhibitor (clopidogrel or ticagrelor) or aspirin after finishing twin remedy following PCI.
After a median follow-up interval of round 4 years, P2Y12 inhibitor remedy was related to a 23% decrease threat of an end result that mixed cardiovascular demise, coronary heart assault, or stroke, in contrast with aspirin, with no vital distinction in main bleeding.
Because of this for each 46 sufferers taking a P2Y12 inhibitor as a substitute of aspirin after twin remedy, one cardiovascular demise, coronary heart assault, or stroke could be prevented.
When contemplating outcomes individually, P2Y12 inhibitor remedy decreased coronary heart assaults and stroke in contrast with aspirin. Nonetheless, all-cause demise, cardiovascular demise, and stent thrombosis have been comparable between the therapies.
The researchers acknowledge that some modifications within the unique design of some trials have been wanted to create uniform information, and that sure traits of particular person trial populations might scale back the generalizability of the findings.
However they are saying no vital distinction in main bleeding between teams was seen, and outcomes have been constant after additional analyses accounting for elements comparable to age, intercourse, geographical area, smoking, earlier coronary heart assault or stroke, underlying situations and drugs historical past, suggesting they’re sturdy.
“Overall, this study supports preferential P2Y12 inhibitor monotherapy prescription over aspirin due to reductions in major adverse cardiac and cerebrovascular events (MACCE) without increasing major bleeding in the medium term,” say researchers in a linked editorial.
Nonetheless, they be aware that “medium-term efficacy does not necessarily extend lifelong, which is the duration we advise patients to continue these medications.”
As such, they recommend that “a large-scale globally representative trial directly comparing different monotherapy strategies (including discontinuation) with extended follow-up would benefit our understanding of the long-term impact of P2Y12 inhibitor monotherapy across the treatment class for secondary prevention following PCI.”
Extra info:
P2Y12 inhibitor or aspirin after percutaneous coronary intervention: particular person affected person information meta-analysis of randomised medical trials, The BMJ (2025). DOI: 10.1136/bmj-2024-082561
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British Medical Journal
Quotation:
P2Y12 medication could also be higher than aspirin to forestall coronary heart assault and stroke in sufferers with coronary artery illness (2025, June 4)
retrieved 4 June 2025
from https://medicalxpress.com/information/2025-06-p2y12-drugs-aspirin-heart-patients.html
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