Pharmacoepidemiol Risk Manage.  2023 Sep;15(2):145-156. 10.56142/perm.23.0014.

Assessment of Clinical Outcomes of Dual Antiplatelet Therapy in Elderly Patients with Percutaneous Coronary Intervention

• Choi JH
• Lee S

• KMID: 2551231
• DOI: http://doi.org/10.56142/perm.23.0014

Abstract

Objective
Dual antiplatelet therapy (DAPT) has been used following percutaneous coronary intervention (PCI) to prevent major adverse cardiovascular events (MACEs). This study aimed to analyze cardiovascular events and bleeding incidents in the elderly on antiplatelet therapy.
Methods
The elderly patients on post-PCI DAPT, aspirin+clopidogrel (AC) and aspirin+ticargrelor (AT), were selected from the Korean Health Insurance Review and Assessment Service–Aged Population Sample (HIRAAPS) in 2017. Patients were excluded if they were on antiplatelets before PCI, had no DAPT, and the follow-up period was less than 30 days. For the study outcomes, negative adverse cardiovascular events (NACE) including bleeding were identified. Incidence rate and time to MACEs were analyzed. The odds ratio of MACEs was assessed by patient characteristics, comorbidities, or concomitant medications.
Results
A total of 153 patients on DAPT of AC (n = 132) and AT (n = 21) were included. NACE was observed in 52 cases (34.0%), comprising 32 cases (20.9%) of MACE and 20 cases (13.1%) of bleeding. In the AC vs. AT groups, the incidence of MACE was 27 (20.5%) vs 5 (23.8%), and bleeding occurred in 17 (12.9%) vs. 3 (14.3%), with no statistical significance. The time to NACE was 69.5 ± 82.3 days and significantly shorter in patients with renal disease (2.8 ± 2.2, p < 0.001), cerebrovascular disease (19.0 ± 19.4, p = 0.002), and liver disease (4.5 ± 2.1, p < 0.001) compared to those without these specific conditions.
Conclusion
Among elderly post-PCI patients with DAPT, NACE was similar between the AC and AT groups. Patients with renal and liver diseases experienced a shorter time to NACE. Post-PCI antiplatelet therapy should be used carefully in the elderly.

Keyword

Antiplatelets; Percutaneous coronary intervention; Major adverse cardiovascular events; Bleeding