Ticagrelor vs. Clopidogrel for Elderly Patients with Acute Coronary Syndromes

Risk for death and bleeding was higher with ticagrelor for octogenarians, in a large observational Swedish registry.

The randomized PLATO study demonstrated in 2009 that ticagrelor was superior to clopidogrel in reducing risk for myocardial infarction, stroke, or death in patients with acute coronary syndromes (ACS; NEJM JW Cardiol Nov 2009 and N Engl J Med 2009; 361:1045). However, more-recent observational studies have suggested less benefit and more bleeding with ticagrelor than with clopidogrel in this setting (e.g., NEJM JW Cardiol Dec 2020 and JAMA 2020; 324:1640).

Given that a key factor associated with higher bleeding risk in ACS patients is older age, investigators compared outcomes with ticagrelor versus clopidogrel among 14,000 elderly patients (≥80 years old) in the SWEDEHEART registry (Heart 2010; 96:1617); of these patients, 32% had ST-segmen…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)