Association of dual antiplatelet therapy with adverse outcomes in octogenarian patients without atrial fibrillation who underwent percutaneous coronary intervention

Abstract

Introduction: Dual antiplatelet therapy is routinely recommended to prevent stent restenosis and reduce ischemic complications after percutaneous coronary intervention. Octogenarians have a higher ischemic burden than younger patients on moreover they have a higher risk of bleeding. Therefore, we intended to analyze and compare the efficacy and safety of clopidogrel and the potent P2Y12 inhibitor ticagrelor in octogenarians undergoing percutaneous coronary intervention without atrial fibrillation. Materials and Methods: This retrospective cohort study analyzed records from three local research hospitals. In our study, 226 patients aged 80 years or older undergoing had coronary intervention for both acute coronary syndrome and stable coronary artery disease were included after the exclusion criteria had been applied between January 2019 and April 2021. Results: The median dual antiplatelet therapy duration was similar between two groups. 84.3% of patients in the clopidogrel group and 56.7% of patients in the ticagrelor group had no bleeding at one year follow-up, which was statistically significant (p<0.001). The minor bleeding rate was significantly higher among patients receiving ticagrelor (21.7%) compared to those receiving clopidogrel (7.2%; p=0.02). Also, the rate of major bleeding was significantly higher in patients receiving ticagrelor (20.0%) than in patients receiving clopidogrel (7.8%; p<0.010). Rates of all-cause death and ischemic endpoints were similar in both treatment groups at one year follow-up. Conclusions: Clopidogrel and ticagrelor were similar in terms of all-cause mortality and ischemic events with increased rates of all types of bleeding in patients treated with ticagrelor. Keywords: Octogenarians; Ticagrelor; Clopidogrel; Hemorrhage; Dual Anti-Platelet Therapy; Aged.