The Best Drug Combo for Clot Prevention

Health Writer
Medically Reviewed

For most people who have suffered a heart attack or had stents implanted, staying with a duo of clot-preventing drugs for at least six months is crucial.

That point is stressed in the latest guidelines on dual antiplatelet therapy from the American College of Cardiology and the American Heart Association. This therapy refers to the combination of low-dose aspirin and any of three P2Y12 inhibitors—namely, clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta). The duo can help reduce the risk of blood clots after a heart attack or angioplasty with stenting.

People who have had a heart attack or unstable angina should almost always stay on low-dose aspirin indefinitely. The same is true for stent patients. What varies is the length of time on a P2Y12 inhibitor. In general, patients given drug-coated stents should stay on the medication for at least six months; those who have recently had a heart attack or unstable angina should stick with the drug for at least 12 months, whether they’ve been treated with angioplasty or medications alone.

There are exceptions. The drug combination carries a risk of internal bleeding, and for people at high risk of bleeding, a shorter time on a P2Y12 inhibitor—three to six months—might be wise. Also, people given bare-metal stents may be able to take a P2Y12 inhibitor for as little as one month.

What’s critical is sticking with your medication for the prescribed amount of time.