Key result
Ticagrelor provided consistent benefits for ischemic outcomes and mortality in elderly and young patients, without increasing major bleeding in the elderly.
Why the study?
Does ticagrelor improve ischemic outcomes without increasing major bleeding in elderly patients?
Key Points
- Assess the efficacy and safety of potent P2Y12 inhibition in elderly patients, focusing on ischemic outcomes and major bleeding risks.
- Evaluated ischemic and bleeding outcomes from the PLATO trial investigating the P2Y12 inhibitor ticagrelor.
- Compared all-cause mortality, cardiovascular mortality, ischemic events, and PLATO-defined major bleeding between elderly and younger cohorts.
- Ticagrelor achieved consistent reductions in ischemic outcomes, including all-cause mortality and cardiovascular mortality, in both elderly and younger patients.
- No increase in PLATO-defined major bleeding occurred in elderly patients receiving potent platelet inhibition.
Structured PICO
Does ticagrelor improve ischemic outcomes without increasing major bleeding in elderly patients?
P
Population
Elderly and young patients
I
Intervention
Ticagrelor (and Prasugrel mentioned in title)
O
Outcome
Ischemic outcomes (including all-cause mortality and cardiovascular mortality)hard clinical
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
AKAdnan KastratiProfessor of cardiology, Deutsches Herzzentrum München
“Our study is the first head-to-head randomized comparison of the reduced dose of prasugrel against standard dose of ticagrelor in elderly and low-weight patients. Specifically designed studies for this subset of patients are very unlikely to be conducted in the future.”
DJDominick J. AngiolilloCardiologist, University of Florida College of Medicine
“An important thing that we address in this review article is the concept that one size does not fit all with regard to our elderly patients. Obviously, the elderly patients who qualify to be enrolled in clinical trials may not be the same as those that we see in real-world clinical practice.”
“While a lower dose seemed intuitive, it was safe but not more effective. Future dedicated studies need to continue to find the right therapies for the vulnerable elderly patients.”
Implication
Ticagrelor provides consistent ischemic benefits without increasing major bleeding risk in elderly patients, based on PLATO study results.
Abstract
get that for the other potent P2Y 12 inhibitor, ticagrelor, with the same reliable platelet inhibition, the results of the PLATO study showed consistent benefits for ischemic outcomes (including reduction in all-cause mortality and cardiovascular mortality) in the elderly and the young, with no increase in PLATO-defined major bleeding even in the elderly.
Discussion
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Cite This Study
Sripal Bangalore (2018) studied this question. Ticagrelor provided consistent benefits for ischemic outcomes and mortality in elderly and young patients, without increasing major bleeding in the elderly.