Antiplatelet therapy in patients aged 70 or older with acute coronary syndrome

This study investigated antiplatelet therapy (APT) in patients aged 70 or older with acute coronary syndrome (ACS). They found that clopidogrel (Plavix) was associated with fewer bleeding events (BEs) in these patients.

Acute coronary syndrome (ACS) is caused by reduced blood flow to the heart. ACS can result in a heart attack. Patients with ACS take medication to reduce the risk of blockages in the coronary arteries. This is called antiplatelet therapy (APT). Usually, patients take two types of drugs – aspirin and a P2Y12 receptor inhibitor. This is called dual APT or DAPT. Clopidogrel is a P2Y12 inhibitor. This reduces the number of platelets in the blood. 

Platelets can form clumps and cause blockages. However, they are also important for normal clotting. P2Y12 inhibitors are associated with a higher bleeding risk (BR). Other inhibitors include ticagrelor (Brilique) and prasugrel (Effient). BR increases with age. It is unclear which P2Y12 inhibitor is most suitable for older patients with ACS.

This study included 1011 patients with ACS. All patients were aged 70 or older. Patients were randomly assigned to 2 groups. Group 1 received clopidogrel (75 mg daily) and group 2 received ticagrelor (90 mg) or prasugrel (10 mg) for 12 months. The main outcome was the number of bleeding events (BEs). The rates of mortality due to ACS were also compared. 

BE rates were significantly lower in group 1 (18% vs 24%). The risk of BEs was 29% lower with clopidogrel treatment. There was no significant difference in mortality rates. 

The authors concluded that clopidogrel was associated with fewer BEs compared to ticagrelor or prasugrel in patients aged 70 or older.

Only 1% of patients were treated with prasugrel. This means that we cannot say that clopidogrel has a lower BE risk than prasugrel, only ticagrelor. More studies are needed. 

If you have any concerns regarding antiplatelet therapy please consult with your doctor.