What is the best blood thinning regimen available?

This study investigated what the best oral blood thinning drug treatment is for patients with sudden decreased blood flow to the heart, a condition also known an acute coronary syndrome. 

Acute coronary syndrome is a term used for any condition caused by a sudden reduced blood flow to the heart. Acute coronary syndrome is most commonly due to atherosclerosis, which is a build up of plaque in the walls of arteries that supply the heart muscle with blood and oxygen. Atherosclerosis causes these arteries to narrow, reducing the blood flow to the heart muscle. If the plaque ruptures, a blood clot can form that dramatically reduces the amount of blood flowing to the heart muscle even more and can result in a heart attack.

Medication used for treating acute coronary syndrome includes antithrombotic drugs. These are drugs that reduce the formation of blood clots, including antiplatelet drugs. Antiplatelet drugs stop platelets in blood from sticking together and thereby stop clots from forming. These drugs are normally given to patients in the form of traditional dual antiplatelet therapy (DAPT). DAPT means that an antiplatelet drug such as clopidogrel is given to a patient along with aspirin. Aspirin thins the blood and reduces the likelihood of blood clotting.

There are newer antiplatelet drugs now available known as P2Y12 inhibitors e.g. prasugrel (Effient) or ticagrelor (Brilinta) which have shown to be stronger acting and have a faster onset of action. Additionally, a different class of antithrombotics, called anticoagulants such as rivaroxaban (Xarelto), also prevent clots from forming.

This study researched past clinical trials that investigated the use of oral antithrombotic drugs in patients with acute coronary syndrome. The study investigated the impact of these drugs on preventing major cardiac events such as a heart attack and side effects such as internal bleeding.

The study included an evaluation of 5 trials with a total of 64,476 acute coronary syndrome patients. The study found that ticagrelor plus aspirin had the highest probability of having the best net benefit (35% likelihood), followed by prasugrel plus aspirin (28%), and rivaroxaban 2.5 mg twice daily plus traditional DAPT (19.5%).

Rivaroxaban 5 mg twice daily plus traditional DAPT was suggested to be the most effective in reducing major adverse cardiac events, but was also associated with the highest risk of internal bleeding. 

The authors suggested that antithrombotic (anti-blood clotting) therapy with ticagrelor plus aspirin may be the optimal antithrombotic regime for patients with acute coronary syndrome. 

Although ticagrelor plus aspirin had the best net benefit profile, it also carries a high risk of thinning the blood too much which can lead to internal bleeding. 

If you or someone you know require antithrombotic treatment and are at risk of having acute coronary syndrome, talk to a doctor about the best and safest medications availble to prevent blood clots.