A major international trial presented at the European Society of Cardiology Congress suggests that one blood-thinning tablet a day may reduce bleeding risk in high-risk patients after a heart stent procedure, though ischaemic events and mortality were reportedly higher in the single-drug group, pointing to a clinical trade-off.
The findings come from the A-CLOSE trial, which looked at patients considered high-risk for a blocked artery (ischaemic event) in the year after having a drug-eluting stent fitted. A drug-eluting stent is a small mesh tube coated in medication, inserted into a narrowed coronary artery to keep it open. The trial found that clopidogrel taken alone was no worse than continuing with dual antiplatelet therapy — a combination of two blood-thinning drugs — when measuring what researchers call net adverse clinical events, meaning a combined count of serious complications including bleeding and clotting.
Standard practice after a drug-eluting stent has typically involved dual antiplatelet therapy (DAPT) for an extended period to reduce the risk of the stent blocking. But bleeding is a known risk with that approach, and clinicians have long debated how long patients genuinely need both drugs. The A-CLOSE results, presented at the European Society of Cardiology (ESC) Congress, suggest clopidogrel monotherapy — one drug rather than two — reduced bleeding risk compared with dual therapy, though ischaemic events and all-cause mortality were higher in the single-drug group — a trade-off that experts say will require individualised clinical decision-making. Ischaemic events occurred in approximately 3.7% of the monotherapy group compared with 1.6% in the dual therapy group, while all-cause mortality was approximately 1.3% versus 0.4% respectively.
The trial was published in the New England Journal of Medicine alongside its congress presentation. The NEJM described the clopidogrel-only approach as “noninferior” to extended dual antiplatelet therapy — meaning it did not perform meaningfully worse on the primary outcome measure.
This is a finding that could matter to a large number of patients. Coronary artery disease and stent procedures are among the most common cardiac interventions carried out by NHS hospitals, including those serving Kent and Medway.
Any change to prescribing practice in England would need to go through NHS clinical guideline bodies such as the National Institute for Health and Care Excellence (NICE). Patients currently on blood-thinning medication after a stent should not change or stop their tablets without speaking to their cardiologist or GP first.
Key information
- Do not stop or alter any heart medication without medical advice — speak to your GP or cardiology team first
- For urgent health concerns, contact NHS 111 online or by phone
- In a medical emergency, call 999
Source: @NEJM