Ticagrelor ups death and bleeding risk in elderly MI patients: SWEDEHEART Registry
Stockholm, Sweden: The use of ticagrelor versus clopidogrel in elderly myocardial infarction (MI) patients increases the risk of death and bleeding, suggests a recent study in the journal Circulation.To determine comparative efficacy and safety of ticagrelor vs. clopidogrel in older MI patients Karolina Szummer, Karolinska University Hospital, Stockholm, Sweden, and colleagues performed...
Stockholm, Sweden: The use of ticagrelor versus clopidogrel in elderly myocardial infarction (MI) patients increases the risk of death and bleeding, suggests a recent study in the journal Circulation.
To determine comparative efficacy and safety of ticagrelor vs. clopidogrel in older MI patients Karolina Szummer, Karolinska University Hospital, Stockholm, Sweden, and colleagues performed an observational analysis of all patients ≥80 years (n = 14,005) who were discharged alive with aspirin combined with either clopidogrel (60.2%) or ticagrelor (39.8%) after MI. The patients were registered in the national registry SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) between 2010 and 2017.
The primary ischemic outcome (death, MI, or stroke) and bleeding were obtained from national registries at 1 year. The researchers also performed a sensitivity analysis in patients <80 years old was performed.
Key findings of the study include:
- In patients ≥80 years, the incidence of the primary ischemic outcome (hazard ratio, 0.97 was similar for ticagrelor- and clopidogrel-treated patients.
- Ticagrelor was associated with a 17% and 48% higher risk of death (1.17) and bleeding (1.48), but a lower risk of MI (0.80) and stroke (0.72).
- In patients <80 years old, incidence of the primary ischemic outcome was 17% lower with ticagrelor.
- Ticagrelor was associated with a 15% (0.85) lower risk of death, 32% higher risk of bleeding (1.32), but lower risk of MI (0.82) and stroke (0.82).
"Ticagrelor use among older MI patients was associated with a higher risk of bleeding and death compared with clopidogrel. A randomized study of ticagrelor versus clopidogrel in the elderly is needed," concluded the authors.
The study, "Comparison Between Ticagrelor and Clopidogrel in Elderly Patients with an Acute Coronary Syndrome: Insights from the SWEDEHEART Registry," is published in the journal Circulation.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.050645
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