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Late-Breaking Science: How does ticagrelor compare with clopidogrel in elderly patients?

As explained in her Late-Breaking Science presentation today, Doctor Karolina Szummer (Karolinska University Hospital, Stockholm, Sweden) and co-investigators used the SWEDEHEART registry to investigate the efficacy and safety of ticagrelor and clopidogrel in elderly patients after a myocardial infarction (MI).

Pharmacology and Pharmacotherapy
Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Cardiovascular Disease in Special Populations

In this comprehensive study, all 14,005 elderly patients (aged ≥80 years) discharged after an MI on aspirin and either clopidogrel (60.2%) or ticagrelor (39.8%) were analysed in the SWEDEHEART registry between 2010 and 2017.

The primary ischaemic outcome of MI, stroke or death was similar for elderly patients treated with ticagrelor compared with clopidogrel (hazard ratio 0.97; 95% confidence interval 0.88–1.06). When the individual components were analysed, ticagrelor was associated with a 20% lower risk of MI (0.80; 0.70–0.92) and a 28% lower risk of stroke (0.72; 0.56–0.93), but there was a 17% higher risk of death (1.17; 1.03–1.32). In addition, ticagrelor was associated with a 48% higher risk of bleeding compared with clopidogrel in the elderly (1.48; 1.25–1.76).

A sensitivity analysis conducted in patients aged <80 years found that the primary ischaemic outcome was 17% lower with ticagrelor (0.83; 0.77–0.89) and there was a lower risk of MI (0.82; 0.75–0.91), stroke (0.82; 0.69–0.98) and death (0.85; 0.76–0.96). However, the risk of bleeding was 32% higher with ticagrelor compared with clopidogrel in younger patients (1.32; 1.18–1.47).

These results highlight different outcomes in elderly vs. younger patients for ticagrelor vs. clopidogrel, with higher risk of bleeding and death. The investigators suggest that a randomised trial is warranted to further assess the use of ticagrelor in elderly patients.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.