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Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial

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 bleed...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601891/
https://www.ncbi.nlm.nih.gov/pubmed/33053622
http://dx.doi.org/10.3390/jcm9103249
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author 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.
author_facet 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.
author_sort Gimbel, Marieke E.
collection PubMed
description 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.
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spelling pubmed-76018912020-11-01 Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial 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. J Clin Med Article 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. MDPI 2020-10-12 /pmc/articles/PMC7601891/ /pubmed/33053622 http://dx.doi.org/10.3390/jcm9103249 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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.
Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
title Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
title_full Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
title_fullStr Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
title_full_unstemmed Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
title_short Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial
title_sort ticagrelor versus clopidogrel in older patients with nste-acs using oral anticoagulation: a sub-analysis of the popular age trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601891/
https://www.ncbi.nlm.nih.gov/pubmed/33053622
http://dx.doi.org/10.3390/jcm9103249
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