Conducted in 51 hospital centers, the AQUATIC study reveals that the addition of aspirin does not reduce the risk of cardiac recurrence but significantly increases the risk of hemorrhage, redefining the guidelines for these fragile patients.
A historical pillar of cardiology called into question
For decades, aspirin has been the symbol of cardiovascular prevention. Its role: to limit platelet aggregation and reduce the risk of clots. But the AQUATIC study, published on October 23, 2025 in The New England Journal of Medicinereveals a surprising observation. According to the Lille University Hospital press release:
“The results of the AQUATIC study are clear and could modify the next international cardiology recommendations by notifying that for chronic coronary patients, including those at high risk, aspirin should not be prescribed long-term in addition to anticoagulant treatment when this is necessary, particularly for atrial fibrillation.”
Over a median follow-up of two years in 872 patients treated with anticoagulants, the addition of aspirin offered no additional protection against cardiac recurrence.
Anticoagulants and aspirin: are they compatible?
The question naturally arises: why do these two treatments coexist? Antiplatelet drugs, such as aspirin, reduce the ability of platelets to form clots. Anticoagulants make the blood less coagulable. Their combination seemed logical to strengthen the prevention of cardiac events.
However, the results of the AQUATIC study show that this duo does not provide the expected benefit. The rigorous methodology carried out by Professors Martine Gilard (Brest), Gilles Lemesle (Lille) and Guillaume Cayla (Nîmes), supported by the FACT network, the ACTION group and the French Society of Cardiology, confirms that caution is necessary.
Bleeding, death… Taking aspirin increases the risk
Beyond its ineffectiveness in preventing recurrences, aspirin increases the risk of serious bleeding. The Lille University Hospital press release specifies:
“Follow-up indicated a significant increase in bleeding with aspirin. Importantly, the prognosis of patients without aspirin was significantly better.”
These bleedings can be catastrophic, especially in patients often aged over 75, the majority population in the cohorts studied. The benefit/risk balance clearly shifts, and the historic therapeutic gesture becomes a potential danger.
What it changes for patients
Concretely, these results offer a new perspective for patients and cardiologists. The prescription of aspirin in coronary patients on anticoagulants could be rethought, improving their safety and quality of life. As the press release points out:
“The application in daily practice of the results of this study will make it possible to improve the prognosis of these coronary patients on anticoagulant.”
Beyond the scientific challenge, this success illustrates the strength of a national collaboration between CHUs, an example of French clinical research of excellence. For patients, this is a concrete step forward: less risk of bleeding and better long-term survival.
The AQUATIC study demonstrates that even the oldest treatments are not immutable in the face of modern evidence. For patients with chronic coronary syndrome, this discovery could transform daily life and provide safer and personalized cardiology.