For patients with a severe heart attack, adding a new generation anticoagulant drug (DOAC), now used to reduce ischemic risk in atrial fibrillation, may be the solution to prevent the risk of stroke, embolism, or new heart attack. Data of an extensive research analysis carried out by Humanitas University supports this and opens new and important scenarios in the treatment of heart attack.

Adding a new generation anticoagulant drug (DOAC), used to reduce thrombotic risk in atrial fibrillation, could be the solution to prevent, even in patients with heart attack, the risk of thrombotic events such as new heart attack, stroke or embolism. The data from an extensive research analysis carried out by Humanitas University and directed by Giulio Stefanini supports this and it is published in JAMA Cardiology:


  • 473 Studies analyzed
  • 19 candidate clinical studies
  • 667 patients with infarction of varying severity in six selected studies


These are the numbers that have led researchers at Humanitas and Humanitas University, in collaboration with San Raffaele and Duke Clinical Research Institute (USA), to highlight the benefits of the association of anticoagulant therapy with new generation drugs in patients with severe heart attack, or characterized by the breakage of an unstable plaque that causes coronary thrombosis and high risk of post-infarction thrombosis.

“Since the arrival on the market of DOAC drugs already used in atrial fibrillation – explains Prof. Giulio Stefanini, cardiologist at Humanitas and researcher at Humanitas University – we have tried to evaluate their use also in the prevention of ischemic events after a heart attack. However, in the studies available to date, the data on the effectiveness of a more intense anti-thrombotic drug strategy, involving the addition of DOAC in all patients, indiscriminately, after myocardial infarction, were questionable. In fact, the price the patient paid in terms of hemorrhagic risk versus anti-ischemic benefits was so high that DOACs are not used in clinical practice after a heart attack.


Anticoagulants: The effectiveness of treatment changes depending on the severity of the infarction

To date, infarction treatment is based on revascularization (angioplasty) followed by therapy with two antiplatelet drugs to reduce the very high thrombotic risk in any type of infarction.

“Starting from the hypothesis that indiscriminate post-infarction administration to all patients was the cause of the poor results – Stefanini continues, we have analyzed all the data available to date to verify whether the efficacy of the new anticoagulant drugs changed according to the patients’ risk profile. For the first time, we found evidence of a very marked antithrombotic benefit of this class of drugs, but only in patients with the most severe type of infarction and, therefore, with a higher thrombotic risk. In these patients, the benefits in terms of antithrombotic protection far outweigh the risk of hemorrhagic complications, while in patients with less severe infarction the use of DOACs is not justified because the risk of hemorrhages cancels out the antithrombotic benefit. This result opens up new and important scenarios in the treatment of heart attacks that need to be confirmed by studies specifically designed only in patients with the most severe heart attacks.