| Autor: |
Gimbel ME; Department of Cardiology, St. Antonius Hospital, 3435CM Nieuwegein, The Netherlands., Tavenier AH; Department of Cardiology, Isala, 8025AB Zwolle, The Netherlands., Bor W; Department of Cardiology, St. Antonius Hospital, 3435CM Nieuwegein, The Netherlands., Hermanides RS; Department of Cardiology, Isala, 8025AB Zwolle, The Netherlands., de Vrey E; Department of Cardiology, Meander Medical Centre, 3813TZ Amersfoort, The Netherlands., Heestermans T; Department of Cardiology, Noord-west Hospital group, 1815JD Alkmaar, The Netherlands., Gin MTJ; Department of Cardiology, Rijnstate, 6815AD Arnhem, The Netherlands., Waalewijn R; Department of Cardiology, Gelre Hospitals, 7334DZ Apeldoorn, The Netherlands., Hofma S; Department of Cardiology, Medical Centre Leeuwarden, 8934AD Leeuwarden, The Netherlands., den Hartog F; Department of Cardiology, Gelderse Vallei Hospital, 6716RP Ede, The Netherlands., Jukema W; Department of Cardiology, Leids University Medical Centre, 2333ZA Leiden, The Netherlands., von Birgelen C; Department of Cardiology, Medisch Spectrum Twente, 7512KZ Enschede, The Netherlands., Voskuil M; Department of Cardiology, University Medical Centre Utrecht, 3584CX Utrecht, The Netherlands., Kelder J; Department of Cardiology, St. Antonius Hospital, 3435CM Nieuwegein, The Netherlands., Deneer V; Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics University, Medical Center Utrecht and Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584CX Utrecht, The Netherlands., Ten Berg JM; Department of Cardiology, St. Antonius Hospital, 3435CM Nieuwegein, The Netherlands. |
| Abstrakt: |
There are no randomised data on which antiplatelet agent to use in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and an indication for oral anticoagulation (OAC). The randomised POPular Age trial, in patients of 70 years or older with NSTE-ACS, showed a reduction in bleeding without increasing thrombotic events in patients using clopidogrel as compared to ticagrelor. In this sub-analysis of the POPular AGE trial, we compare clopidogrel with ticagrelor in patients with a need for oral anticoagulation. The follow-up duration was one year. The primary bleeding outcome was Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding. The primary thrombotic outcome consisted of cardiovascular death, myocardial infarction and stroke. The primary net clinical benefit outcome was a composite of all-cause death, myocardial infarction, stroke, and PLATO major and minor bleeding. A total of 184/1011 (18.2%) patients on OAC were included in this subanalysis; 83 were randomized to clopidogrel and 101 to ticagrelor. The primary bleeding outcome was lower in the clopidogrel group (17/83, 20.9%) compared to the ticagrelor group (33/101, 33.5%; p = 0.051), as was the thrombotic outcome (7/83, 8.4% vs. 19/101, 19.2%; p = 0.035) and the primary net clinical benefit outcome (23/83, 27.7% vs. 49/101, 48.5%; p = 0.003). In this subgroup of patients using OAC, clopidogrel reduced PLATO major and minor bleeding compared to ticagrelor without increasing thrombotic risk. This analysis therefore suggests that, in line with the POPular Age trial, clopidogrel is a better option than ticagrelor in NSTE-ACS patients ≥70 years using OAC. |
