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 examine printed by The BMJ.
P2Y12 inhibitors are sometimes given to sufferers alongside aspirin (“twin remedy”) after percutaneous coronary intervention (PCI)—a process to widen or unblock a coronary artery—to assist forestall cardiovascular occasions together with coronary heart assault and stroke.
After a number of months, sufferers are often switched from twin remedy to lifelong aspirin, however some trials have urged {that a} P2Y12 inhibitor could also be more practical for long-term prevention than aspirin.
To discover this additional, researchers analyzed particular person affected person knowledge from 5 randomized medical trials involving 16,117 sufferers (common age 65; 24% girls) 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.
Which means for each 46 sufferers taking a P2Y12 inhibitor as a substitute of aspirin after twin remedy, one cardiovascular demise, coronary heart assault, or stroke can be prevented.
When contemplating outcomes individually, P2Y12 inhibitor remedy lowered coronary heart assaults and stroke in contrast with aspirin. Nonetheless, all-cause demise, cardiovascular demise, and stent thrombosis have been comparable between the remedies.
The researchers acknowledge that some modifications within the unique design of some trials have been wanted to create uniform knowledge, and that sure traits of particular person trial populations could cut 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 strong.
“General, this examine helps preferential P2Y12 inhibitor monotherapy prescription over aspirin attributable to reductions in main antagonistic cardiac and cerebrovascular occasions (MACCE) with out rising main bleeding within the medium time period,” say researchers in a linked editorial.
Nonetheless, they observe that “medium-term efficacy doesn’t essentially prolong lifelong, which is the period we advise sufferers to proceed these drugs.”
As such, they recommend that “a large-scale globally consultant trial instantly evaluating totally different monotherapy methods (together with discontinuation) with prolonged follow-up would profit our understanding of the long-term affect of P2Y12 inhibitor monotherapy throughout the therapy class for secondary prevention following PCI.”
Extra info:
P2Y12 inhibitor or aspirin after percutaneous coronary intervention: particular person affected person knowledge meta-analysis of randomised medical trials, The BMJ (2025). DOI: 10.1136/bmj-2024-082561
Quotation:
P2Y12 medicine could also be higher than aspirin to forestall coronary heart assault and stroke in sufferers with coronary artery illness (2025, June 4)
retrieved 5 June 2025
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