Antithrombotic Therapy Strategies and Clinical Outcomes in Chinese Patients Aged 65 and Older with High Ischemic Risk Coronary Artery Disease

Background: Elderly patients with coronary artery disease (CAD) are at heightened risk for ischemic and bleeding complications. This study evaluates antithrombotic therapy use and its clinical outcomes in Chinese patients aged ≥ 65 years with CAD and elevated ischemic risk. Methods: This prospective cohort study enrolled patients aged ≥ 65 years with diagnosed CAD and ≥ 1 high ischemic risk factor from two centers. We recorded major adverse cardiovascular events (MACE)—death, nonfatal myocardial infarction, nonfatal ischemic stroke—and bleeding events over a 2-year follow-up. Results: Of 1005 patients (mean age 76.3 ± 7.2 years; 25.3% female), 49.0% were aged 65– 75 and 51.0% were > 75. Antithrombotic regimens included no therapy (1.8%), single antiplatelet therapy (SAPT, 23.0%), dual antiplatelet therapy (DAPT, 64.3%), and anticoagulation (10.9%), with 60.9% of the latter combining antiplatelet therapy. Older patients (> 75 years) experienced higher MACE rates (11.5% vs 6.3%; RR: 1.825; 95% CI: 1.203– 2.769; p = 0.004) and a trend towards increased bleeding (8.4% vs 6.5%; p = 0.257). Notably, all-cause and cardiovascular mortality were significantly higher in this group. Anticoagulation therapy was linked to a higher, yet non-significant, MACE rate and significantly increased bleeding risk compared to SAPT and DAPT. Multivariate analysis identified age > 75, LVEF < 50%, and eGFR < 50 mL/min/1.73 m 2 as predictors of mortality and MACE, with anticoagulation therapy increasing bleeding risk. Conclusion: In elderly CAD patients, those aged > 75 years exhibit higher mortality and MACE rates, with anticoagulation therapy associated with increased bleeding. Age, reduced LVEF, and renal function emerge as critical predictors of adverse outcomes.