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Area of Science:

  • Gerontology
  • Pharmacology
  • Epidemiology

Background:

  • Limited real-world safety data exists for antithrombotic use in elderly patients with multiple health conditions.
  • Antithrombotic therapies include monotherapy, dual antiplatelet therapy (DAPT), and triple therapy (TT).

Purpose of the Study:

  • To investigate the bleeding risks (gastrointestinal and intracranial) associated with antithrombotic monotherapy, DAPT, and TT in individuals aged 65 and older.
  • To provide real-world evidence on antithrombotic safety in a population often excluded from clinical trials.

Main Methods:

  • A case-crossover design was used, analyzing hospital discharge data from 2005-2014.
  • Conditional logistic regression estimated adjusted relative risks (ARR) for bleeding events in individuals aged 65+.

Main Results:

  • The study included 66,500 individuals with gastrointestinal (GI) or intracranial (IC) bleeding events.
  • DAPT use increased IC-bleeding risk (ARR=3.13) and GI-bleeding risk (ARR=1.34) compared to no antithrombotic use.
  • Triple therapy (TT) showed the highest increased risk for IC-bleeding (ARR=17.28) and GI-bleeding (ARR=4.85).

Conclusions:

  • Antithrombotic use, particularly triple therapy, is associated with significantly elevated bleeding risks in older adults.
  • Population-level data provides crucial safety insights for antithrombotic agents in elderly individuals with comorbidities.