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Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Elderly Patients Undergoing Percutaneous
Shaoke Meng1, Lei Guo1, Zhishuai Ye2
1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.
Insights
Ticagrelor use in elderly patients undergoing percutaneous coronary intervention (PCI) significantly increased bleeding events compared to clopidogrel. This dual antiplatelet therapy (DAPT) strategy did not improve major adverse cardiovascular and cerebrovascular events (MACCEs).
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Advanced age is a significant risk factor for adverse outcomes, including increased risks of bleeding and ischemia.
- Elderly patients often have comorbidities that complicate treatment decisions, particularly regarding antithrombotic therapies.
Purpose of the Study:
- To evaluate the safety and efficacy of ticagrelor compared to clopidogrel in elderly patients (≥75 years) following percutaneous coronary intervention (PCI).
- To assess the impact of ticagrelor-based dual antiplatelet therapy (DAPT) on bleeding events and major adverse cardiovascular and cerebrovascular events (MACCEs) in this population.
Main Methods:
- Retrospective analysis of 1505 patients (≥75 years) who underwent PCI and received DAPT between January 2015 and December 2019.
- Patients were divided into ticagrelor and clopidogrel groups, with follow-up for 1 year.
- Primary safety endpoint: Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding. Primary efficacy endpoint: MACCEs. Propensity score matching and Cox proportional hazard models were used.
Main Results:
- The ticagrelor group (442 patients) showed a significantly higher incidence of BARC 2, 3, and 5 bleeding (HR 2.304) and any bleeding (HR 2.476) compared to the clopidogrel group (1063 patients).
- No significant differences were observed between the groups regarding BARC 3 and 5 bleeding (HR 1.566) or MACCEs (HR 0.957).
- Propensity score matching analysis confirmed these findings, highlighting an increased bleeding risk with ticagrelor without a corresponding efficacy benefit.
Conclusions:
- In elderly patients undergoing PCI, ticagrelor-based DAPT is associated with a significantly increased risk of bleeding events compared to clopidogrel.
- The use of ticagrelor in this elderly population did not demonstrate a reduction in MACCEs, suggesting a potentially unfavorable risk-benefit profile.
- These findings underscore the need for careful consideration of antithrombotic strategies in elderly patients, balancing bleeding risk against ischemic benefit.
Background:
Age is a strong predictor of adverse outcomes due both to a higher risk of bleeding and ischemia. The purpose of this study was to evaluate the safety and efficacy of ticagrelor in elderly patients.
Methods:
Patients ≥75 years of age admitted to our center from January, 2015 to December, 2019 who had undergone percutaneous coronary intervention (PCI) and received dual antiplatelet therapy (DAPT) were included in our study. Eligible patients were divided into clopidogrel and ticagrelor groups according to the P2Y12 receptor inhibitor and were followed up for 1 year. The primary safety endpoint was types 2, 3, and 5 bleeding, as defined by Bleeding Academic Research Consortium (BARC), and the primary efficacy endpoint was combined major adverse cardiovascular and cerebrovascular events (MACCEs). A Cox proportional hazard model and propensity score matching were used to correct confounding factors.
Results:
Of 1505 patients enrolled in this study, 442 were assigned to ticagrelor group and 1063 were assigned to clopidogrel group. The incidence of BARC 2, 3, and 5 bleeding (HR, 2.304; 95% CI, 1.540-3.447), and any bleeding (HR, 2.476; 95% CI, 1.802-3.403) in ticagrelor group was significantly higher than clopidogrel group. There were no significant difference between the two groups with respect to BARC 3 and 5 bleeding (HR, 1.566; 95% CI, 0.767-3.198) and MACCEs (HR, 0.957; 95% CI, 0.702-1.305).
Conclusion:
Compared with clopidogrel, DAPT with ticagrelor significantly increased the risk of BARC 2, 3, and 5 bleeding without reducing MACCEs in elderly patients who underwent PCI.
Trial Registration:
The study was retrospectively registered in clinicaltrials.gov (NCT04999293).
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