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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Elderly patients with acute coronary syndromes managed without revascularization: Insights into the safety of long-term dual antiplatelet therapy with reduced-dose prasugrel versus standard-dose clopidogrel
Circulation, Volume 128, No. 8, Year 2013
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Description
BACKGROUND - : Dual antiplatelet therapy in older versus younger patients with acute coronary syndromes is understudied. Low-dose prasugrel (5 mg/d) is recommended for younger, lower-body-weight patients and elderly patients with acute coronary syndromes to mitigate the bleeding risk of standard-dose prasugrel (10 mg/d). METHODS AND RESULTS - : A total of 9326 medically managed patients with acute coronary syndromes from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial (<75 years of age, n=7243; ≥75 years of age, n=2083) were randomized to prasugrel (10 mg/d; 5 mg/d for those ≥75 or <75 years of age and <60 kg in weight) or clopidogrel (75 mg/d) plus aspirin for ≤30 months. A total of 515 participants ≥75 years of age (25% of total elderly population) had serial platelet reactivity unit measurements in a platelet-function substudy. Cumulative risks of the primary end point (cardiovascular death/myocardial infarction/stroke) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding increased progressively with age and were ≥2-fold higher in older participants. Among those ≥75 years of age, TIMI major bleeding (4.1% versus 3.4%; hazard ratio, 1.09; 95% confidence interval, 0.57-2.08) and the primary end point rates were similar with reduced-dose prasugrel and clopidogrel. Despite a correlation between lower 30-day on-treatment platelet reactivity unit values and lower weight only in the prasugrel group, there was a nonsignificant treatment-by-weight interaction for platelet reactivity unit values among participants ≥75 years of age in the platelet-function substudy (P=0.06). No differences in weight were seen in all participants ≥75 years of age with versus without TIMI major/minor bleeding in both treatment groups. CONCLUSIONS - : Older age is associated with substantially increased long-term cardiovascular risk and bleeding among patients with medically managed acute coronary syndromes, with no differences in ischemic or bleeding outcomes with reduced-dose prasugrel compared with clopidogrel in elderly patients. No significant interactions among weight, pharmacodynamic response, and bleeding risk were observed between reduced-dose prasugrel and clopidogrel in elderly patients. © 2013 American Heart Association, Inc.
Authors & Co-Authors
Roe, Matthew T.
United States, Durham
Duke University Medical Center
United States, Durham
Duke University School of Medicine
Goodman, Shaun G.
Canada, Toronto
Saint Michael's Hospital University of Toronto
Öhman, Erik Magnus
United States, Durham
Duke University Medical Center
United States, Durham
Duke University School of Medicine
Stevens, Susanna R.
United States, Durham
Duke University Medical Center
Hochman, Judith S.
United States, New York
Nyu Grossman School of Medicine
Gottlieb, Shmuel L.
Israel, Jerusalem
Shaare Zedek Medical Center
Martínez, Felipe A.
Argentina, Cordoba
Universidad Nacional de Córdoba
Dalby, Anthony John
South Africa, Johannesburg
Milpark Hospital
Boden, William E.
United States, Albany
Albany Medical College
White, Harvey D.
New Zealand, Auckland
Auckland City Hospital
Prabhakaran, Dorairaj
India, New Delhi
Centre for Chronic Disease Control
Winters, Kenneth J.
United States, Indianapolis
Eli Lilly and Company
Aylward, Philip E.G.
Australia, Adelaide
Flinders University
Bassand, Jean Pierre L.
France, Besancon
Hopital Jean Minjoz
McGuire, Darren K.
United States, Richardson
The University of Texas at Dallas
Ardissino, Diego
Italy, Parma
Azienda Ospedaliero-universitaria Di Parma
Fox, Keith A.A.
United Kingdom, Edinburgh
The University of Edinburgh
Armstrong, Paul W.
Canada, Edmonton
University of Alberta
Statistics
Citations: 127
Authors: 18
Affiliations: 17
Identifiers
Doi:
10.1161/CIRCULATIONAHA.113.002303
ISSN:
00097322
e-ISSN:
15244539
Research Areas
Environmental
Noncommunicable Diseases
Study Design
Cross Sectional Study