Comparative effectiveness and safety of dual antiplatelet therapy with ticagrelor vs. clopidogrel in older adults with acute coronary syndrome: a target trial emulation study
Authors' conclusion
In ACS patients aged ≥75 years, ticagrelor was associated with a lower risk of MACE than clopidogrel. There were no differences in major bleeding, although the confidence interval was wide.
Study context
- Population
- Acute coronary syndromes (ACS) patients ≥75 years initiating dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel, Stockholm region healthcare data (2011–2021)older patients, median age, 81 years (IQR, 77–85), 49% ticagrelor, 51% clopidogrel
- Participants
- 4,637 patients
- Comparison
- Ticagrelor vs. clopidogrel
- Outcome
- Major adverse cardiovascular events (MACE):
- Cardiovascular death
- Myocardial infarction
- Stroke
- Follow-up
- one-year
Methodological detailsinverse probability of treatment weighting
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
Each group vs clopidogrelAR difference (95% CI)
Ticagrelor
−3.8%(−6.8 to −0.8)
Each group vs clopidogrelHazard ratio (95% CI)
Ticagrelor
0.73(0.56–0.95)
Safety
| Outcome | Ticagrelor | Clopidogrel | HR (95% CI) | |
|---|---|---|---|---|
| Major bleeding · one-yearNo difference | 4.3% | 4.8% | 0.89 (0.63–1.27) | |
| 0.512Hazard ratio (log scale) |
Original publication
Comparative effectiveness and safety of dual antiplatelet therapy with ticagrelor vs. clopidogrel in older adults with acute coronary syndrome: a target trial emulation study. Eur Heart J Cardiovasc Pharmacother. Published 14 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it