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New bloodthinner not always better PhD defense Paulo Zocca

Cardiac patients undergoing percutaneous coronary intervention treatment (PCI) are not always better off with a new type of blood thinner, which is advised in international guidelines instead of a commonly used older medicine. This is the main finding of a study performed by Paolo Zocca, cardiologist at Thorax Center Twente. Zocca obtained his PhD on 13 December on his research at the University of Twente.

Paolo Zocca has carried out research into various types of blood thinners that are prescribed to patients with a heart attack who undergo a PCI. These blood thinners reduce the risk of a clot in the stent or a new heart attack. Usually a stent, which is a tube of thin metal wire, is placed during a PCI treatment. The stent ensures that the narrowed blood vessel is kept open.

New blood thinner

International guidelines recommend the use of the newer and stronger blood thinner ticagrelor, instead of the long-used clopidogrel (both in addition to a low dose of aspirin). That advice came about on the basis of a study in which patients received the older generation of stents. In the current study, the effects of both blood thinners have been compared in patients who are treated with the older generation stents to patients in which modern drug-releasing stents are used instead.

Blood thinners just as effective

In patients with a modern stent, the old clopidogrel drug appears to be just as effective as ticagrelor. It also emerges that the risk of major bleeding is clearly increased with the new drug. Severe bleeding occurs primarily in patients who already have an increased risk of bleeding, such as the elderly or patients with anemia or impaired renal function.

Another consideration

The investigation will not result in ticagrelor no longer being prescribed. However, the results have ensured that prescribing is more careful and that patients with a high risk of bleeding can safely opt for the old blood thinner clopidogrel.

TWENTE trials

Zocca has also conducted comparative research into the effectiveness and safety of different types of modern drug-releasing stents, conducted within the "TWENTE trials" research series. Patients were randomly implanted with different types of stents during PCI. To date we have not found any significant signals that one stent is performing better than the other. All stents implanted by us were found to be safe and effective.

About this research

Paolo Zocca is a cardiologist at the Thorax Center Twente, in training as an interventional cardiologist. The study Dual antiplatelet therapy after stenting in all-comers, ACS patients and in high bleeding risk was conducted under the supervision of promoter Prof. C. von Birgelen, cardiologist, and co-promoter Dr. C. Doggen of the University of Twente.