Key result
Prasugrel or ticagrelor offers no efficacy benefit over clopidogrel in elderly ACS but increases bleeding ~17%.
Why the study?
The safety and efficacy of DAPT in elderly patients with ACS is not well characterized.
Does DAPT with prasugrel or ticagrelor increase bleeding or improve efficacy compared to clopidogrel in elderly patients with ACS?
Meta-Analysis (n=29,217)
Does DAPT with prasugrel or ticagrelor increase bleeding or improve efficacy compared to clopidogrel in elderly patients with ACS?
Effect estimate: RR 0.85 (95% CI 0.68-1.07)
p-value: p=0.17
In elderly patients with ACS, using more potent P2Y12 inhibitors (prasugrel or ticagrelor) instead of clopidogrel increases bleeding risk without significantly improving efficacy.
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Potent P2Y12 inhibitors raise bleeding without efficacy gain versus clopidogrel in elderly ACS; challenges routine use and supports age-specific trials.
Croix et al. (2022) conducted a meta-analysis in Acute coronary syndrome (n=29,217). Prasugrel or ticagrelor vs. Clopidogrel was evaluated on Primary efficacy endpoint (RR 0.85, 95% CI 0.68-1.07, p=0.17). Prasugrel or ticagrelor compared to clopidogrel in elderly patients with ACS showed no difference in primary efficacy (RR 0.85; 95% CI 0.68-1.07) but increased bleeding risk (RR 1.17; P<0.05).
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