Research directed by Professor Giulio Stefanini, specialist in Cardiology Interventions in Humanitas and lecturer at Humanitas University, published in the journal JAMA Cardiology, has shown how Direct Oral AntiCoagulants (DOAC) could be a therapeutic option in patients with a severe heart attack, in order to prevent subsequent thrombotic events of blood vessel occlusion, such as stroke, embolism or new strokes. The hypothesis shall be confirmed by new studies before it can be put into clinical practice.
As Prof. Stefanini explains: “In patients with an infarction, an acute ischemia with non-arrival of the blood in an area of the heart, an antithrombotic therapeutic strategy is followed, reducing the risk of a new occlusion of the blood vessels with anti-aggregant drugs, which act by blocking the action of aggregation of the platelets in the formation of the thrombus. In fact, patients who have had a heart attack have a high risk of encountering new episodes of thrombosis. Moreover, in the early hours of the attack, an enlargement of the heart zone damaged by the lack of blood flow, anti-aggregant drugs are used to reduce this risk.
New anticoagulants
“The new generation of oral anticoagulants, which do not act on platelets but directly on blood clotting systems, keeping it fluid, were initially used for the prevention of embolisms in patients with or at risk of deep vein thrombosis or in cases of atrial fibrillation; conditions that promote the formation of embolisms that, transported by the blood, can go to obstruct blood vessels.
Only later were they attempted to be used in patients with heart attacks, verifying that they effectively reduced the risk of new ischemic thrombosis episodes, but at the same time were associated with an excessive risk of bleeding, with the consequent abandonment of their use in these cases,” the specialist pointed out.
The patient with infarction is currently treated in hemodynamics with vascularization (angioplasty), followed by treatment with anti-aggregant drugs.
New anticoagulants and heart attacks: benefits and risks
In the research published in JAMA Cardiology and carried out by Humanitas in collaboration with the San Raffaele Hospital in Milan and the Duke Clinical Research Institute in the United States, Prof. Stefanini examined the benefits and risks of new-generation anticoagulant drugs in heart attacks, reviewing the various data collected in works already published, but dividing the results according to the severity of the heart attack. “We have carried out an analysis of a number of clinical studies by providing access to individual research data, including unpublished data, on specific subpopulations of patients,” he explains.
Researchers were able to use information from nearly 30,000 patients from 6 studies, selected from a sample of 19 candidate clinical studies from 473 initially found studies. “We saw that, by categorizing and separately considering the risk of patients based on the severity of the infarction, in cases with a more severe infarction the benefit of preventing new thrombotic episodes outweighed the risk of bleeding, with a net benefit to the patient, while a zero effect was confirmed in cases with a less severe infarction, as the reduction of the risk of thrombosis and new ischemia was balanced by the increased risk of bleeding, thus not justifying the use of DOACs in these patients,” Professor Stefanini said.
“For the first time, we found evidence of a very marked antithrombotic benefit of this class of drugs, but only in patients with the most severe type of infarction and, therefore, with a higher risk of thrombosis. The findings open up new and important scenarios in the treatment of heart attacks, which need to be confirmed by studies specifically designed only for patients with the most severe heart attacks,” concluded Professor Stefanini.
