Key result
Tirofiban and ticagrelor linked to in-hospital bleeding, which affects ~13% of elderly ACS patients.
Why the study?
Elderly patients with ACS remain susceptible to in-hospital bleeding compared with younger patients despite therapeutic advances, prompting investigation into incidence, risk factors, bleeding sites, and associated mortality.
Do potent antiplatelet agents increase the risk of in-hospital bleeding in elderly patients (≥ 75 years) with acute coronary syndrome?
Observational (n=539)
Do potent antiplatelet agents increase the risk of in-hospital bleeding in elderly patients (≥ 75 years) with acute coronary syndrome?
Odds Ratio: 4.43 (95% CI 1.78–10.99)
p-value: p=<0.01
In elderly patients with ACS, the use of potent antiplatelet agents like ticagrelor and tirofiban is associated with a significantly increased risk of in-hospital bleeding.
Potent antiplatelet use may increase bleeding in elderly ACS; leaves open causal effects pending randomized trials.
Despite implementation of new interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome (ACS) continue to be susceptible to in-hospital bleeding compared with younger ones. Thus, we investigated the incidence of in-hospital bleeding events and associated risk factors in elderly (≥ 75°years) ACS patients. We also wanted to define the bleeding sites, characteristics, and associated mortality. Bleeding Academic Research Consortium (BARC) classification type 2, 3, or 5 was used to define bleeding events. Overall, 539 patients were included in the study (mean age: 82.5 ± 4.8°years; 282 (52.3%) females). Of these patients, 69 (12.8%) developed in-hospital bleeding. Factors that were independently related with in-hospital bleeding were age (odds ratio (OR): 1.08; 95% confidence interval (CI): 1.011.14, P = .01), acute kidney injury (OR: 3.66; 95% CI: 2.016.69; P < .01), tirofiban (OR: 4.43; 95% CI: 1.7810.99; P < .01), and ticagrelor (OR: 1.93; 95% CI: 1.013.73; P = .04) administration. The urinary tract was the most frequent bleeding site, followed by femoral arteries. In conclusion, ticagrelor and tirofiban should be used with caution in elderly ACS patients.
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Keskin et al. (2022) conducted an observational in Acute coronary syndrome (n=539). Potent antiplatelet agents (tirofiban and ticagrelor) vs. No administration of potent antiplatelet agents was evaluated on In-hospital bleeding (BARC type 2, 3, or 5) (OR 4.43, 95% CI 1.78-10.99, p=<0.01). Among elderly patients with acute coronary syndrome, in-hospital bleeding occurred in 12.8%, with tirofiban (OR 4.43) and ticagrelor (OR 1.93) identified as independent risk factors.
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