P2Y12 inhibitors associated with lower cardiovascular events compared to aspirin

P2Y12 inhibitors associated with lower cardiovascular events compared to aspirin

Giving a P2Y12 inhibitor anti-trafficking drug to patients with coronary artery disease is associated with lower rates of cardiovascular death, heart attack and stroke compared to traditional aspirin, without an increased risk of major bleeding, finds a study published byThe BMJToday.

P2Y12 inhibitors are often given alongside aspirin (“dual therapy”) after percutaneous coronary intervention (PCI) – a procedure to widen or unblock a coronary artery – to prevent cardiovascular events such as heart attack and stroke.

After several months, patients are usually switched from dual therapy to lifelong aspirin, but some studies have suggested that a P2Y12 inhibitor is more effective than aspirin for long-term prevention.

To investigate this further, researchers analyzed individual patient data from five randomized clinical trials involving 16,117 patients (mean age 65; 24% women) who were assigned to a P2Y12 inhibitor (clopidogrel or ticagrelor) or aspirin after completing dual therapy after PCI.

After an average follow-up of around 4 years, P2Y12 inhibitor therapy was associated with a 23% lower risk of an outcome combining cardiovascular death, heart attack or stroke compared with aspirin, without a significant difference in major bleeding. This means that for 46 patients who take a P2Y12 inhibitor instead of aspirin after dual therapy, one cardiovascular death, heart attack or stroke will be prevented.

When the results were considered individually, P2Y12 inhibitor therapy reduced heart attacks and strokes compared to aspirin. However, all-cause death, cardiovascular death, and stent thrombosis were similar between treatments.

The researchers acknowledge that some changes in the original design of some experiments were necessary to produce consistent data and that certain characteristics of individual experimental populations may reduce the generalizability of the results.

However, they say no significant difference in major bleeding was observed between groups, and the results were consistent after further analyzes accounted for factors such as age, gender, geographic region, smoking, previous heart attack or stroke, underlying conditions and medication history, suggesting they are robust.

"Overall, this study supports preferential p2y12 inhibitor monotherapy prescription over aspirin due to reduction in major adverse cardiac and cerebrovascular events (MACCE) without increased major bleeding in the medium term," researchers say in a linked editorial.

However, they note that "mid-term effectiveness does not necessarily extend lifespan, which is the length of time we advise patients to continue these medications."

Therefore, they suggest that "a globally representative study combining direct monotherapy strategies (including discontinuation) with extended follow-up will benefit our understanding of the long-term effects of P2Y12 inhibitor monotherapy in the secondary prevention treatment class after PCI."

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