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Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis

BACKGROUND: Bleeding is an untoward outcome in the management of elderly patients with acute coronary syndrome (ACS). Although the potent oral P2Y12 inhibitor, ticagrelor is clinically beneficial, its association with bleeding events in elderly ACS patients (≥75 years) is poorly understood. METHODS:...

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Autores principales: Alaamri, Shalan, Dalbhi, Sultan Al
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568350/
https://www.ncbi.nlm.nih.gov/pubmed/34871206
http://dx.doi.org/10.1097/MD.0000000000027398
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author Alaamri, Shalan
Dalbhi, Sultan Al
author_facet Alaamri, Shalan
Dalbhi, Sultan Al
author_sort Alaamri, Shalan
collection PubMed
description BACKGROUND: Bleeding is an untoward outcome in the management of elderly patients with acute coronary syndrome (ACS). Although the potent oral P2Y12 inhibitor, ticagrelor is clinically beneficial, its association with bleeding events in elderly ACS patients (≥75 years) is poorly understood. METHODS: We conducted a systematic search of 7 databases up to May 20, 2020 to identify studies which examined the risk of bleeding (defined according to each study) among elderly ACS patients (≥75 years) receiving ticagrelor compared to clopidogrel. Summary risk ratios (RR) were estimated using the random effects model. RESULTS: Eight studies consisting of 5 observational studies and 3 randomized controlled trials involving 7032 elderly patients met the eligibility criteria. The mean age of the patients was 77.8 years, and the mean follow-up duration was 12 months. Overall, the pooled RRs showed higher risk of a bleeding event with ticagrelor compared to clopidogrel (RR 1.20, 95% confidence interval [95% CI] 1.03–1.40; P = .017). No statistically significant heterogeneity was observed among the studies (Q = 6.93; P = .44; I(2) = 0). Also, pooled RRs did not show a higher risk of major bleeding (RR 1.32, 95% CI 0.91–1.92; P = .15) or minor bleeding (RR 1.09, 95% CI 0.76–1.58; P = .64) when comparing the ticagrelor to the clopidogrel group. CONCLUSIONS: There is a 20% increased risk of a bleeding event in elderly ACS patients treated with ticagrelor compared to clopidogrel; for such patients, clopidogrel may be considered as an alternative agent to ticagrelor due to its lower risk of bleeding.
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spelling pubmed-85683502021-11-06 Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis Alaamri, Shalan Dalbhi, Sultan Al Medicine (Baltimore) 3400 BACKGROUND: Bleeding is an untoward outcome in the management of elderly patients with acute coronary syndrome (ACS). Although the potent oral P2Y12 inhibitor, ticagrelor is clinically beneficial, its association with bleeding events in elderly ACS patients (≥75 years) is poorly understood. METHODS: We conducted a systematic search of 7 databases up to May 20, 2020 to identify studies which examined the risk of bleeding (defined according to each study) among elderly ACS patients (≥75 years) receiving ticagrelor compared to clopidogrel. Summary risk ratios (RR) were estimated using the random effects model. RESULTS: Eight studies consisting of 5 observational studies and 3 randomized controlled trials involving 7032 elderly patients met the eligibility criteria. The mean age of the patients was 77.8 years, and the mean follow-up duration was 12 months. Overall, the pooled RRs showed higher risk of a bleeding event with ticagrelor compared to clopidogrel (RR 1.20, 95% confidence interval [95% CI] 1.03–1.40; P = .017). No statistically significant heterogeneity was observed among the studies (Q = 6.93; P = .44; I(2) = 0). Also, pooled RRs did not show a higher risk of major bleeding (RR 1.32, 95% CI 0.91–1.92; P = .15) or minor bleeding (RR 1.09, 95% CI 0.76–1.58; P = .64) when comparing the ticagrelor to the clopidogrel group. CONCLUSIONS: There is a 20% increased risk of a bleeding event in elderly ACS patients treated with ticagrelor compared to clopidogrel; for such patients, clopidogrel may be considered as an alternative agent to ticagrelor due to its lower risk of bleeding. Lippincott Williams & Wilkins 2021-11-05 /pmc/articles/PMC8568350/ /pubmed/34871206 http://dx.doi.org/10.1097/MD.0000000000027398 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle 3400
Alaamri, Shalan
Dalbhi, Sultan Al
Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis
title Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis
title_full Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis
title_fullStr Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis
title_full_unstemmed Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis
title_short Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis
title_sort risk of bleeding with ticagrelor in elderly patients over 75 years old: a systematic review and meta-analysis
topic 3400
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568350/
https://www.ncbi.nlm.nih.gov/pubmed/34871206
http://dx.doi.org/10.1097/MD.0000000000027398
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