Your heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.
Medications you are likely to be prescribed after a heart attack fall into the following classes:
Antiplatelet agents – to prevent blood clots and keep the stent open. Examples include aspirin, clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). It is critical that these medicines not be stopped without checking with your cardiologist, for stopping them prematurely can result in another heart attack from the stent closing off abruptly.
Statins – to lower cholesterol levels. Examples include atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor) and pravastatin (Pravachol).
Beta blockers – to treat high blood pressure and decrease the incidence of abnormal heart rhythms. They can also help the heart remodel and improve heart function. They decrease the amount of work the heart has to do. Beta blockers after a heart attack have increased survival rates. Examples include metoprolol (Lopressor, Toprol XL), carvedilol (Coreg), nebivolol (Bystolic), atenolol (Tenormin) and bisoprolol (Zebeta).
ACE-inhibitors/Angiotensin receptor blockers (ARBs) – to lower blood pressure. They can also help the heart remodel and improve heart function. ACE-inhibitors after large heart attacks have increased survival. Examples of ACE-inhibitors include lisinopril (Prinivil, Zestril), ramipril (Altace), captopril (Capoten), quinapril (Accupril) and enalapril (Vasotec). Examples of ARBs include losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar) and azilsartan (Edarbi).
Calcium channel blockers – to reduce blood pressure and control the amount of calcium that enters the heart and arteries, allowing blood vessels to relax and reducing the workload of the heart. An example is verapamil (Isoptin SR, Calan SR).
Nitrates – to expand the arteries leading to the heart and relieve chest pain. Examples include sublingual nitroglycerin, isosorbide (Imdur), isosorbide dinitrate (Isordil) and the nitroglycerin patch.
Antianginal agents – to relieve chest pain. Besides nitrates (see above), ranolazine (Ranexa) may also be given to help decrease chest pain.
Anticoagulants – to reduce the blood's ability to clot. If there is evidence of a blood clot in the heart after a heart attack, then warfarin (Coumadin) may be used to eventually dissolve the clot. If there is evidence for a certain type of abnormal heart rhythm, then depending on one's risk for stroke, warfarin (Coumadin), dabigatran (Pradaxa) or rivaroxaban (Xarelto) may be prescribed to thin the blood and decrease the risk for stroke
Medications to protect the stomach – Because a heart attack is a stressful event, and subsequent medication regimens to keep the stent clear often include aspirin and other antiplatelet agents that can be tough on the stomach and increase the chance for bleeding from the stomach, your cardiologist may (or may not) recommend medications to protect the stomach. Examples include H2 blockers such as cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac), or proton pump inhibitors such as pantoprazole (Protonix).
An Important Note About Aspirin and Other Antiplatelet Medications
After you suffer a heart attack, you should take aspirin every day for the rest of your life. If you receive a bare metal stent you should also take Plavix, Effient, or Brilinta for a minimum of a month after the procedure. If you receive drug-eluting (coated) stents you need to take Plavix, Effient, or Brilinta for at least a year after stent implantation. Taking these medications exactly as prescribed is critically important to prevent a blood clot from potentially forming in the stent.