Key result
Advancing age linked to ~5% lower odds of ticagrelor selection over clopidogrel in ACS.
Why the study?
International guidelines strongly recommend potent P2Y12 inhibitors such as ticagrelor for ACS patients, yet real-world adherence frequently deviates in developing nations. The sociodemographic and laboratory predictors driving clinicians to select clopidogrel versus ticagrelor in this setting needed evaluation.
Do sociodemographic factors (such as age) and baseline laboratory parameters (such as aPTT) influence the selection of ticagrelor versus clopidogrel in patients with acute coronary syndrome undergoing PCI?
Cross-Sectional (n=254)
No
Do sociodemographic factors (such as age) and baseline laboratory parameters (such as aPTT) influence the selection of ticagrelor versus clopidogrel in patients with acute coronary syndrome undergoing PCI?
In real-world Indonesian clinical practice, clinicians overwhelmingly favor clopidogrel over guideline-recommended ticagrelor for ACS patients undergoing PCI, driven independently by older patient age and prolonged baseline aPTT as a heuristic to mitigate bleeding risk.
May reflect bleeding-risk heuristics limiting ticagrelor in ACS; leaves open whether age- and aPTT-guided selection improves net outcomes.
Background: Although international guidelines strongly recommend potent P2Y12 inhibitors (ticagrelor) for acute coronary syndrome (ACS) patients, real-world clinical adherence frequently deviates, creating a distinct evidence-practice gap, particularly in developing nations. Aim: This retrospective cross-sectional study aimed to evaluate sociodemographic and laboratory predictors influencing the selection of dual antiplatelet therapy (clopidogrel versus ticagrelor) among 254 ACS patients at a tertiary hospital in Jakarta from January to December 2025. Methode: Data were extracted from medical records and analyzed using multivariate binary logistic regression. Result: The results demonstrated that the vast majority of the cohort (83.8%, n=213) received an aspirin-clopidogrel combination, whereas only 16.1% (n=41) were initiated on ticagrelor. Multivariate analysis identified age and baseline activated partial thromboplastin time (aPTT) as significant independent predictors of therapy selection, specifically revealing that advancing age (aOR 0.946; 95% CI: 0.910–0.983; p=0.005) and prolonged baseline aPTT (aOR 0.854; 95% CI: 0.763–0.992; p=0.039) substantially reduced the probability of ticagrelor prescription. These findings establish that advanced age and prolonged baseline aPTT operate as independent determinants driving clinicians to de-escalate P2Y12 therapy to clopidogrel. Conclusion: This highlights the application of a heuristic approach in real-world clinical practice, where mitigating bleeding risk in vulnerable demographics is systematically prioritized over maximizing the efficacy of potent anti-ischemic agents.
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Isfani et al. (2026) conducted a cross-sectional in Acute coronary syndrome undergoing percutaneous coronary intervention (n=254). Advancing age (per 1-year increase) and prolonged baseline aPTT vs. Lower age and shorter baseline aPTT was evaluated on Selection of ticagrelor over clopidogrel as part of dual antiplatelet therapy (with aspirin) (OR 0.946, 95% CI 0.910-0.983, p=0.005). Advancing age (aOR 0.946, p=0.005) and prolonged baseline aPTT (aOR 0.854, p=0.039) independently reduced the likelihood of ticagrelor prescription over clopidogrel in ACS patients.
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