Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
| Autor: | Gimbel, Marieke E, Tavenier, Anne H, Bor, Wilbert, Hermanides, Renicus S, de Vrey, Evelyn, Heestermans, Ton, Gin, Melvyn Tjon Joe, Waalewijn, Reinier, Hofma, Sjoerd, den Hartog, Frank, Jukema, Wouter, von Birgelen, Clemens, Voskuil, Michiel, Kelder, Johannes, Deneer, Vera, Ten Berg, Jurriën M, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology |
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| Přispěvatelé: | Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Acute coronary syndrome
medicine.medical_specialty lcsh:Medicine 030204 cardiovascular system & hematology elderly Article ticagrelor 03 medical and health sciences 0302 clinical medicine Older patients non-vitamin K oral anticoagulation (NOAC) vitamin K antagonists (VKA) Internal medicine medicine 030212 general & internal medicine Myocardial infarction cardiovascular diseases Stroke Oral anticoagulation clopidogrel business.industry lcsh:R General Medicine medicine.disease Clopidogrel non-ST-segment elevation myocardial infarction (NSTEMI) business Ticagrelor Nste acs medicine.drug |
| Zdroj: | Journal of Clinical Medicine, 9(10). MDPI AG Journal of Clinical Medicine Journal of Clinical Medicine, Vol 9, Iss 3249, p 3249 (2020) Journal of Clinical Medicine, 9(10). MDPI Volume 9 Issue 10 |
| ISSN: | 2077-0383 |
| Popis: | 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 &ge 70 years using OAC. |
| Databáze: | OpenAIRE |
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