Efficacy and Safety of Aspirin with Anticoagulant in Patients with High Risk of Thrombotic Events
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on November 19th, 2025
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Long-term anticoagulation therapy is commonly prescribed to prevent recurrent thrombotic events in patients with chronic coronary disease. While previous studies have shown that combining anticoagulant and antiplatelet therapy increases bleeding risk, many of those trials were limited by a lack of blinding and the inclusion of predominantly low-risk patients. To address these limitations, a study funded by the French Ministry of Health and Bayer investigated whether adding aspirin to an anticoagulant regimen would provide additional benefits in patients at high risk of thrombotic events.
The trial enrolled 872 participants with an average age of 71 years, all diagnosed with chronic coronary syndrome and previously treated with coronary stent placement. Among them, 72.1% had a history of myocardial infarction, and 26.5% had experienced heart failure. The median baseline CHA₂DS₂-VASc score was 4, indicating a substantial risk of stroke.
All patients received either a direct oral anticoagulant or a vitamin K antagonist and were randomly assigned to receive an additional 100 mg of aspirin daily or a placebo. After a two-year follow-up, the study found that adding aspirin to anticoagulant therapy significantly increased the risk of major cardiovascular events, including cardiovascular death, myocardial infarction, and stroke. Furthermore, aspirin use was associated with a threefold increase in bleeding risk. These findings suggest that in patients with chronic coronary disease and high thrombotic risk, the combination of aspirin with anticoagulants may cause more harm than benefit.
The trial enrolled 872 participants with an average age of 71 years, all diagnosed with chronic coronary syndrome and previously treated with coronary stent placement. Among them, 72.1% had a history of myocardial infarction, and 26.5% had experienced heart failure. The median baseline CHA₂DS₂-VASc score was 4, indicating a substantial risk of stroke.
All patients received either a direct oral anticoagulant or a vitamin K antagonist and were randomly assigned to receive an additional 100 mg of aspirin daily or a placebo. After a two-year follow-up, the study found that adding aspirin to anticoagulant therapy significantly increased the risk of major cardiovascular events, including cardiovascular death, myocardial infarction, and stroke. Furthermore, aspirin use was associated with a threefold increase in bleeding risk. These findings suggest that in patients with chronic coronary disease and high thrombotic risk, the combination of aspirin with anticoagulants may cause more harm than benefit.