New research from University of Alabama at Birmingham scientists, published in International Journal of Cardiology: Heart & Vasculature, claims that the use of dual therapy leads to fewer bleeding events with a marginal increase in the risk of ischemic events in patients with atrial fibrillation undergoing interventions for heart attacks.
Atrial fibrillation, or irregular heartbeat, affects nearly 30 million individuals worldwide. Almost one in five of these patients undergoes stent procedures for clots in their coronary arteries. These patients require two different types of blood thinners, antiplatelets and anticoagulants, for decreasing the risk of stroke and a repeat episode of arterial clots. At the same time, these patients have risk factors like increasing age, which puts them at an enhanced risk of bleeding from these blood thinners.
“Therefore, it is crucial to balance the risk of clotting with bleeding in these patients,” said Kartik Gupta, M.D., a research fellow in the Division of Cardiovascular Disease. “The ideal strategy for blood thinners remains elusive.”
The analysis of five randomized control trials with 9,931 patients suggests that use of dual therapy — one antiplatelet and one anticoagulant — decreased the risk of major bleeding. There was no increase in the risk of clots as compared with use of triple therapy — two antiplatelets and one anticoagulant. The use of dual therapy reduced the risk of major bleeding by 45 percent compared to the use of triple therapy.
“No increase in the risk of clots could be found because these trials were not primarily focused to investigate the increase in clots,” said Navkaran Bajaj, M.D., the senior author of the study. “Future trials should focus on this important aspect of use of blood thinners.”