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Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis

Shalan Alaamri1, Sultan Al Dalbhi2

  • 1Cardiology Department, College of Medicine, Jeddah University, Saudi Arabia.

Medicine
|December 6, 2021
PubMed

Insights

Elderly patients with acute coronary syndrome (ACS) face a higher bleeding risk with ticagrelor compared to clopidogrel. Clopidogrel may be a safer alternative for this population due to its lower bleeding risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • Bleeding complications are a significant concern in elderly patients diagnosed with acute coronary syndrome (ACS).
  • While ticagrelor offers clinical benefits, its bleeding risk in ACS patients aged 75 years and older requires further investigation.

Purpose of the Study:

  • To systematically evaluate the risk of bleeding events associated with ticagrelor compared to clopidogrel in elderly patients (≥75 years) with ACS.

Main Methods:

  • A systematic literature search was performed across seven databases up to May 20, 2020.
  • Eight studies, including observational studies and randomized controlled trials with 7032 patients, were analyzed.
  • Risk ratios (RR) for bleeding events were calculated using a random-effects model.

Main Results:

  • The pooled analysis revealed a significantly higher risk of any bleeding event with ticagrelor versus clopidogrel (RR 1.20, P=.017).
  • No significant increase in major bleeding (RR 1.32, P=.15) or minor bleeding (RR 1.09, P=.64) was observed.
  • No statistically significant heterogeneity was detected among the included studies (I²=0, P=.44).

Conclusions:

  • Elderly ACS patients treated with ticagrelor exhibit a 20% increased risk of bleeding compared to those on clopidogrel.
  • Clopidogrel presents a potentially safer alternative for elderly ACS patients due to its associated lower bleeding risk.
Abstract

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