Do the benefits outweigh the risks when using new anticoagulants with antiplatelet therapy after a heart attack?

This study looked at whether there were any benefits to adding a new generation anticoagulant to antiplatelet medication after a heart attack.

After a heart attack, patients are usually given antiplatelet medication – drugs that stop the initial stages of blood clot formation. Typically, they receive a combination of two drugs: aspirin and clopidogrel (Plavix). It is hypothesized that by adding anticoagulants to this regimen, a further reduction in complications could be achieved. Anticoagulants are drugs which stop blood clotting in a different way than antiplatelet medication. They are powerful substances with recognized benefits, but are also associated with a significant risk of bleeding accidents. Newer anticoagulants are generally safer and require less monitoring with regular blood tests. Examples of new anticoagulants: apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) etc. Adding anticoagulants to antiplatelet medications following a heart attack may help to further reduce the risk of complications.

The present article reviewed currently published medical literature and identified a total of 30866 patients from 7 different studies who had received one of the new anticoagulants after a heart attack. They had been given the medication in addition to antiplatelet therapy with aspirin alone or aspirin plus clopidogrel.

Results showed that in patients treated with the new anticoagulants and aspirin alone, there was a 30% decrease in major cardiac events (such as another heart attack), but also a 79% increase in bleeding events. In patients treated with both aspirin and clopidogrel, adding anticoagulation decreased the rate of major cardiac events by 13% but increased bleeding events by as much as 134%.

In conclusion, adding one of the new anticoagulants to antiplatelet agents reduced heart attack complications but at the price of a significantly increased bleeding risk.

This study involved a literature review and analysis of already published trials performed by different research groups. Some patients nowadays may also be on even more powerful antiplatelet drugs, which may further lessen the benefits of anticoagulation.