New Treatment Options to Prevent Another Heart Attack 

This article is for people who may have another heart attack, or anyone who wants to learn more about new treatment options to prevent a heart attack. The goal of this patient education activity is to inform you about blood thinners as a treatment for heart disease, so you can gain knowledge and confidence to discuss taking blood thinners with your doctor.

You will learn:

• Why you may be at risk for another heart attack

• How you can lower your risk for another heart attack, including taking blood thinners

• If blood thinners are right for you

• What the side effects of blood thinners are

• How to live a heart-healthy lifestyle

Did you know that if you had a heart attack recently or even a few years ago, you have a chance of having another one? Even if you are feeling "fine" right now and are taking aspirin, that might not be enough to lower your risk for another heart attack.

Whether it is your first or second heart attack, it is important to know about ways to help prevent having another heart attack. There are many lifesaving treatment options for people with heart disease to prevent repeat heart attacks from happening.

Almost every 40 seconds, someone in the United States will have a heart attack

Reference: American Heart Association, 2017

Risk factors for having another heart attack include:

• Previous heart attack or stroke

• Previous heart surgery

• High cholesterol

• High blood pressure

• Diabetes

• Coronary artery disease (cholesterol buildup in the arteries of your heart)

• Peripheral artery disease (cholesterol buildup in the arteries of your arms and legs)

• Kidney disease

• Heart failure

• Current smoker

• Being overweight

• Not getting enough exercise

You can lower your risk for another heart attack by taking your prescribed medicines to manage other health conditions and by maintaining a heart-healthy lifestyle.

As a reminder, call 9-1-1 immediately if you have any of these symptoms:

• Chest pain or pressure that comes back after rest

• Pressure, tightness, pain, or squeezing in your chest or arms that can move to your neck, jaw, or back

• Shortness of breath

• Stomach pain or nausea

• Other symptoms: cold sweat, dizziness, feeling very tired

Women may not have the same symptoms as men. Some women experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness, fainting, upper back pressure, or feeling very tired. If in doubt, call 9-1-1!

Most heart attacks result from a buildup of cholesterol (called plaque) inside a coronary artery. When plaque breaks off inside an artery, a blood clot (or clump of plaque, platelets, and red blood cells) can form, blocking blood flow and oxygen supply to the heart.

Treatment options to prevent a heart attack include:

• Medicines to reduce stress on the heart (ie, lowering cholesterol and blood pressure; improving oxygen flow to your heart)

• Surgical or nonsurgical procedures to improve blood flow to the heart

• Medicines called blood thinners to prevent blood clots from forming and blocking blood flow to your heart

There are surgical and nonsurgical procedures that improve blood flow to the heart by rerouting blood flow, opening the artery, or removing blockage such as:

• Coronary artery bypass graft surgery (CABG): connects blood vessels from another part of the body to blood vessels around the blocked artery in the heart

• Angioplasty: a small balloon is inflated inside your blocked artery to open it up

• Stent implantation: during angioplasty, a thin mesh tube, or "stent," is placed to permanently keep the artery open

• Atherectomy: an invasive procedure that removes plaque that's blocking the artery

If you have one of these procedures, you will still need to take medicines to lower your risk for a heart attack.

Stent Placement After Angioplasty

Antiplatelet medicines are a type of blood thinner that have been around for a long time to treat people with heart disease. These medicines stop platelets in the blood from sticking to plaque and forming a clot.

After having your first heart attack, your doctor would have recommended aspirin. Some people may be taking aspirin and another antiplatelet medicine that is stronger than aspirin, like clopidogrel, prasugrel, or ticagrelor, after a heart attack or a procedure (such as a stent or CABG).

Antiplatelet Agents Used to Treat Heart Disease
Aspirin Clopidogrel (Plavix®) Prasugrel (Effient®) Ticagrelor (Brilinta®)

Anticoagulants are blood thinners that are a bit different and newer than antiplatelet agents. A DOAC (direct oral anticoagulant) is a type of anticoagulant that slows down the body's process of making blood clots and stops red blood cells from forming a clot in the veins.

DOACs have been used to prevent blood clots in people with an abnormally fast heartbeat (called atrial fibrillation) or in people who get blood clots in their legs or lungs (called venous thromboembolism). A DOAC called rivaroxaban can be used along with aspirin to prevent blood clots in people with heart disease and lower the risk for a heart attack.

Even if you are being treated with other medicines to lower your cholesterol and blood pressure, as well as antiplatelet agents, you may need some extra help from a DOAC to prevent a heart attack.

Anticoagulant to Treat Heart Disease
Rivaroxaban (Xarelto®) with aspirin

DOAC therapy with aspirin may be right for you if:

• Had a heart attack 1 year ago or longer, or have plaque buildup in many arteries in your heart

• Have a high risk of having another heart attack and a low risk of bleeding with blood thinner therapy

High Risk of Heart Attack	Low Risk of Bleeding
You have plaque in many blood vessels plus any of these: Diabetes Previous heart attack Peripheral artery disease Kidney disease Heart failure	Younger age Not frail Good kidney function No history of bleeding in the brain or stomach No history of anemia due to stomach bleed No history of stroke (blood clot in brain) No liver failure No bleeding disorder

People on blood thinners can have serious side effects. Call your doctor if you have any of these problems:

• Unusual pain/swelling/discomfort

• Unusual bruising

• Bleeding for a long time from cuts, the gums, shaving

• Nosebleeds that are uncommon or that don't stop

• Coughing up blood

• Blood in vomit or urine

• Blood in stools, or dark tarry stools

• Severe headache, dizziness/fainting, feeling tired

• Trouble swallowing

After having a heart attack, it is important to continue a heart healthy lifestyle to prevent it from happening again. Along with taking your medicines, practice these healthy habits:

• Quit smoking

• Lose weight if you are overweight

• Choose a healthy eating pattern

• Be physically active for at least 20 minutes, 3 to 4 times a week

• Limit alcohol

• Manage stress

• Get 7 to 9 hours of sleep

Ask your doctor these questions to find out how you can lower your risk for another heart attack and if a DOAC may be appropriate for you:

• What are my risk factors for another heart attack?

• Should I be taking a DOAC?

• What do you recommend I do to keep my heart healthy?

• When should I get emergency help?

Congratulations!

You have successfully completed the program: New Treatment Options to Prevent Another Heart Attack

View Additional Materials

View Additional Materials on this topic that you may find useful:

University of Chicago Medicine: Symptoms of a Heart Attack

American Heart Association: Heart Attack

American Heart Association: Heart Attack Recovery FAQs

American Heart Association: Heart Attack Tools and Resources

Centers for Disease Control and Prevention: Heart Disease Facts