Combination Antiplatelet Therapy Raises Risk of Bleeding

Combination Antiplatelet Therapy Raises Risk of Bleeding

Millions of Americans are taking blood thinner medication to reduce their risk of developing dangerous blood clots, which can lodge in the heart or the brain and lead to a heart attack or stroke. "As with all drugs, these drugs come with risks," says Dr. Nadine Shebab of the US Centers for Disease control and Prevention (CDC), "The most serious is bleeding." Anti clotting medications are often prescribed after a heart attack or stroke to reduce the risk of a second one.

In an attempt to better understand the risks, the CDC used national databases to identify emergency department visits for bleeding made by patients prescribed the common blood thinner warfarin, and those using a combination therapy of the popular anti clotting drugs Plavix (clopidogrel) and aspirin. They examined data from a two-year period, uncovering 384 annual bleeding related emergency department visits among patients taking the combination antiplatelet therapy, and 2,986 annual visits for those on warfarin.

That translates to 1.2 hospital visits for bleeding for every 1000 prescriptions for dual antiplatelet medications, and 2.5 visits for every 1000 warfarin prescriptions. "This wasn't as big a difference as we had thought," said Shebab, noting that the risks of bleeding from the common blood thinner medication combination of Plavix and aspirin was not as well understood as the risk of bleeding from warfarin (generic Coumadin). The most common reasons for the emergency room visits for those taking the combination of blood thinner medications were nosebleed or other minor bleeding.

Shebab called the less than expected gap in the risk between the two therapies "worrisome". "There is an inclination in the clinical community to treat the risk of hemorrhagic risk of dual antiplatelet therapy a little bit less seriously than [that of] warfarin. We hope that by shedding some light on the burden and the nature of the bleeding risks of dual platelet therapy that providers will take the risk seriously."

American Heart Association spokesman Dr. Gregg Fonarow, a professor of cardiology at the University of California, stresses that the benefits of dual platelet therapy outweigh the risks. "The use of dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the rick of cardiovascular events in patients after acute coronary syndromes and patients undergoing coronary stenting," Fonarow says, "These finding reinforce the need for patients receiving dual antiplatelet therapy to be well-educated on the benefits of treatment and the importance of adherence, but also the increased risk of major and minor bleeding."

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