• Posted June 6, 2025

There's A Better Clot-Preventing Option Than Aspirin, Researchers Say

There’s a better option than daily aspirin to protect heart patients with a stent against dangerous blood clots, a new study found.

A class of drugs called P2Y12 inhibitors that includes ticagrelor and clopidogrel could be more effective than low-dose aspirin in preventing heart attacks and strokes, researchers reported June 4 in The BMJ.

Stent recipients prescribed long-term P2Y12 inhibitor treatment had a 23% lower risk of heart-related death, heart attack or stroke compared to those given aspirin, results showed.

That means that one death, heart attack or stroke could be prevented for every 46 people taking a P2Y12 inhibitor instead of aspirin, researchers said.

These drugs work by blocking a receptor on the surface of platelets, the blood cells responsible for creating clots. This makes the platelets less sticky, reducing their ability to clump together.

P2Y12 inhibitors “reduced the five-year incidence of cardiovascular death, myocardial infarction, or stroke and a net composite outcome including both major ischemic events and major bleeding compared with aspirin,” concluded the research team led by Dr. Marco Valgimigli, deputy chief of cardiology at the Cardiocentro Ticino Institute in Lugano, Switzerland.

People with a narrowed or blocked heart artery are often treated by doctors reopening the artery and then placing a stent inside to keep it open.

Following this procedure, patients are given P2Y12 inhibitors and aspirin as dual therapy to prevent a blood clot from forming in the newly placed stent.

After several months, patients typically switch from this dual therapy to lifelong aspirin, but some studies have suggested that PY212 inhibitors might be even better at preventing future heart problems.

For this study, researchers pooled data from five previous clinical trials involving more than 16,000 patients with an average age of 65.

These patients were assigned to take either clopidogrel, ticagrelor or aspirin after completing dual therapy anti-clotting treatment for their new stent.

After an average follow-up of four years, the P2Y12 inhibitors proved more beneficial than daily aspirin with about the same risk of bleeding, results showed.

The benefits largely came from lower rates of heart attack and stroke, researchers noted. Death from any cause, heart-related death, and stent clots were similar between the P2Y12 and aspirin groups.

An accompanying editorial by U.K. researchers agreed that the study shows a benefit from the anti-clotting drugs, but argued that it’s too soon to start switching people over from aspirin.

“Although now off-label, clopidogrel remains more expensive than aspirin, and comprehensive health economic evaluation is required to better understand cost effectiveness,” wrote the editorial team led by Rohin Reddy of Imperial College London.

More research into the long-term effectiveness and safety of the drugs compared to aspirin is needed, the editorialists added.

“Medium term efficacy does not necessarily extend lifelong, which is the duration we advise patients to continue these medications,” the editorial said.

More information

The National Institutes of Health has more on P2Y12 inhibitors.

SOURCES: The BMJ, news release, June 4, 2025; The BMJ, June 4, 2025