Comparison Between Ticagrelor and Clopidogrel in Elderly Patients with an Acute Coronary Syndrome: Insights from the SWEDEHEART Registry

Secondary analysis of a study (n=14,005) found that, in those ≥80 years, the incidence of the primary ischaemic outcome was similar for ticagrelor and clopidogrel, but ticagrelor was associated with a 17% and 48% higher risk of death & bleeding, respectively

SPS commentary:

In those <80yrs the ischaemia outcome was 17% lower for ticagrelor, and the risk of death was also lower by 15%.  Authors highlight, that due to the differences in outcomes in older patients, a randomised study of ticagrelor vs clopidogrel in the elderly is needed.

According to a commentary, risk stratification, based on scores and careful assessment of additional coexisting comorbidities/general health status conditions impacting thrombotic and/or bleeding risk, should drive a more considered choice of ticagrelor over clopidogrel in clinical practice.  The optimal selection of an oral P2Y12 inhibitor (ticagrelor, low-dose prasugrel or clopidogrel) in elderly patients post-MI should weigh up  a multitude of factors, as this can make all the difference.



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