Ticagrelor Ups Death And Bleeding Risk In Elderly MI Patient
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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.

The comparative efficacy and safety of ticagrelor vs. clopidogrel in older myocardial infarction (MI) patients has received limited study.

Researchers performed an observational analysis of all patients ?80 years who were discharged alive with aspirin combined with either clopidogrel (60.2%) or ticagrelor (39.8%) after a MI registered in the national registry Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).

Inverse probability treatment weighting was used in Cox regression models to adjust for differences in demographics, in-hospital therapies, and medications. The primary ischemic outcome (death, MI or stroke), and bleeding were obtained from national registries at 1 year. A sensitivity analysis in <80-year-old patients was performed.

Results:
-- In patients ?80 years, the incidence of the primary ischemic outcome 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 <80-year-old patients the incidence of the primary ischemic outcome was 17% (0.83) lower with ticagrelor.
Ticagrelor was associated with 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).

Conclusively, Ticagrelor use among elderly MI patients was associated with higher risk of bleeding and death compared with clopidogrel. A randomized study of ticagrelor vs clopidogrel in the elderly is needed.

Source: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050645
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