Brilinta With Aspirin No Better Than Aspirin Alone for Heart Surgery Patients: Study

Researchers determined that patients given both drugs experienced higher risks of bleeding problems and other side effects, with few to no benefits.

A new study suggests that adding Brilinta to an aspirin regimen after heart surgery provided no additional protection against heart attack or stroke, and may have increased the risk of these adverse events.

According to findings published this fall in The New England Journal of Medicine, people who had heart surgery and took Brilinta and aspirin in the year following the surgery faced higher rates of major bleeding, heart attacks, strokes and even death.

Brilinta (ticagrelor) is an antiplatelet medication used to prevent blood clots, heart attacks and strokes among high-risk heart patients, especially after they have undergone coronary-artery bypass grafting (CABG) surgery. It works by preventing blood platelets from sticking together to form clots that can block arteries and cause side effects.

The risk of blood clots is significantly higher after heart surgery and following a heart attack, making antiplatelet therapy critical to long-term patient outcomes. For this reason, doctors often prescribe dual antiplatelet therapy, which combines aspirin with another medication, to further reduce the risk of clot-related complications such as heart attacks and strokes.

However, some reports have linked Brilinta to an increased risk of side effects, including a patient’s risk of suffering serious bleeding problems. Research published in 2022 indicated Brilinta tripled the risk of significant bleeding events after CABG surgery compared to using aspirin.

Led by Dr. Anders Jeppsson, researchers from Sahlgrenska University Hospital in Sweden conducted a registry-based clinical trial across 22 Nordic cardiothoracic surgery centers. The study followed 2,200 coronary artery bypass graft patients who received either Brilinta plus aspirin or aspirin alone for one year after surgery.

Findings indicate patients in both groups suffered similar rates of side effects, including heart attacks, strokes, repeat surgeries and death. However, the net number of side effects was much higher among the Brilinta plus aspirin group.

Overall, 8% of the Brilinta plus aspirin group suffered side effects compared to 6% among the aspirin only group.

Similarly, 5% of patients in the Brilinta plus aspirin group suffered major bleeding events, while 2% of patients in the aspirin only group suffered major bleeding side effects.

“In this trial, the addition of ticagrelor to aspirin for the prevention of death, myocardial infarction, stroke, or repeat revascularization during the first year after CABG for an acute coronary syndrome was not superior to aspirin alone.”

— Dr. Anders Jeppsson, Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome

The researchers conclude that using dual platelet therapy combining Brilinta and aspirin did not decrease their risk of heart attack, stroke or death one year after surgery. Moreover, the study highlights other research indicating that the combination of Brilinta and aspirin increases the patient’s likelihood of suffering bleeding side effects, such as major hemorrhaging.

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