Table 4.
Age-specific data in randomized studies about alternative long-term antithrombotic strategies.
| Single Antiplatelet | ||||||
|---|---|---|---|---|---|---|
| Study | ACS Presentation (%) | PCI Rate (%) | Elderly Patients (%) | Groups | Follow-Up (m) |
Main Results |
| HOST EXAM [64,65] | STEMI (17.1%), NSTE-ACS (54.9%) | 100% | ≥65 y (43.4%) | Clopidogrel vs. ASA |
24 | Clopidogrel compared to ASA monotherapy significantly reduced the risk of ischemic events and major bleedings. No significant influence by age. |
| Long DAPT | ||||||
| DAPT [66] | STEMI (10.5%), NSTE-ACS (32.2%) | 100% | ≥75 y (10.4%) | ASA + P2Y12i (clopidogrel 65%; prasugrel 35%) vs. ASA only |
30 | DAPT, compared with aspirin therapy alone, significantly reduced the risks of ischemic events, but with an increased risk of bleeding. The efficacy benefit of prolonged DAPT was attenuated by age and bleeding rates increased with age. |
| PEGASUS-TIMI 54 [67] | STEMI (53.5%), NSTE-ACS (40.5%) | 83% | ≥75 y (14.6%) | Ticagrelor 90 mg + ASA vs. ticagrelor 60 mg + ASA vs. ASA + placebo |
36 | Ticagrelor significantly reduced the risk of ischemic events and increased the risk of major bleeding. The efficacy was also confirmed in elderly patients but with an increased risk of bleeding. |
| DAT | ||||||
| COMPASS [69] | History of myocardial infarction (62.2%) | 53.9% | ≥75 y (20.9%) | Rivaroxaban 2.5 mg + ASA vs. ASA + placebo |
36 | Rivaroxaban plus ASA reduced the rate of ischemic events with increased risk of bleeding compared with ASA alone.. Despite no significant interaction with age, among elderly patients the magnitude of benefit with DAT was reduced, and the relative increase in major bleeding was higher. |
m = months, y = years.