Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial (2024)

Gimbel, M. E., Tavenier, A. H., Bor, W., Hermanides, R. S., de Vrey, E., Heestermans, T., Gin, M. T. J., Waalewijn, R., Hofma, S., den Hartog, F., Jukema, W., von Birgelen, C., Voskuil, M., Kelder, J., Deneer, V., & Ten Berg, J. M. (2020). Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial. Journal of Clinical Medicine, 9(10), Article 3249. https://doi.org/10.3390/jcm9103249

Gimbel, Marieke E ; Tavenier, Anne H ; Bor, Wilbert et al. / Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation : A Sub-Analysis of the POPular Age Trial. In: Journal of Clinical Medicine. 2020 ; Vol. 9, No. 10.

@article{5a1d31a2257949b99650212bfc60e182,

title = "Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial",

abstract = "There are no randomised data on which antiplatelet agent to use in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and an indication for oral anticoagulation (OAC). The randomised POPular Age trial, in patients of 70 years or older with NSTE-ACS, showed a reduction in bleeding without increasing thrombotic events in patients using clopidogrel as compared to ticagrelor. In this sub-analysis of the POPular AGE trial, we compare clopidogrel with ticagrelor in patients with a need for oral anticoagulation. The follow-up duration was one year. The primary bleeding outcome was Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding. The primary thrombotic outcome consisted of cardiovascular death, myocardial infarction and stroke. The primary net clinical benefit outcome was a composite of all-cause death, myocardial infarction, stroke, and PLATO major and minor bleeding. A total of 184/1011 (18.2%) patients on OAC were included in this subanalysis; 83 were randomized to clopidogrel and 101 to ticagrelor. The primary bleeding outcome was lower in the clopidogrel group (17/83, 20.9%) compared to the ticagrelor group (33/101, 33.5%; p = 0.051), as was the thrombotic outcome (7/83, 8.4% vs. 19/101, 19.2%; p = 0.035) and the primary net clinical benefit outcome (23/83, 27.7% vs. 49/101, 48.5%; p = 0.003). In this subgroup of patients using OAC, clopidogrel reduced PLATO major and minor bleeding compared to ticagrelor without increasing thrombotic risk. This analysis therefore suggests that, in line with the POPular Age trial, clopidogrel is a better option than ticagrelor in NSTE-ACS patients ≥70 years using OAC.",

keywords = "non-ST-segment elevation myocardial infarction (NSTEMI), elderly, non-vitamin K oral anticoagulation (NOAC), vitamin K antagonists (VKA), ticagrelor, clopidogrel",

author = "Gimbel, {Marieke E} and Tavenier, {Anne H} and Wilbert Bor and Hermanides, {Renicus S} and {de Vrey}, Evelyn and Ton Heestermans and Gin, {Melvyn Tjon Joe} and Reinier Waalewijn and Sjoerd Hofma and {den Hartog}, Frank and Wouter Jukema and {von Birgelen}, Clemens and Michiel Voskuil and Johannes Kelder and Vera Deneer and {Ten Berg}, {Jurri{\"e}n M}",

year = "2020",

month = oct,

day = "12",

doi = "10.3390/jcm9103249",

language = "English",

volume = "9",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

publisher = "MDPI AG",

number = "10",

}

Gimbel, ME, Tavenier, AH, Bor, W, Hermanides, RS, de Vrey, E, Heestermans, T, Gin, MTJ, Waalewijn, R, Hofma, S, den Hartog, F, Jukema, W, von Birgelen, C, Voskuil, M, Kelder, J, Deneer, V & Ten Berg, JM 2020, 'Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial', Journal of Clinical Medicine, vol. 9, no. 10, 3249. https://doi.org/10.3390/jcm9103249

Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial. / Gimbel, Marieke E; Tavenier, Anne H; Bor, Wilbert et al.
In: Journal of Clinical Medicine, Vol. 9, No. 10, 3249, 12.10.2020.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation

T2 - A Sub-Analysis of the POPular Age Trial

AU - Gimbel, Marieke E

AU - Tavenier, Anne H

AU - Bor, Wilbert

AU - Hermanides, Renicus S

AU - de Vrey, Evelyn

AU - Heestermans, Ton

AU - Gin, Melvyn Tjon Joe

AU - Waalewijn, Reinier

AU - Hofma, Sjoerd

AU - den Hartog, Frank

AU - Jukema, Wouter

AU - von Birgelen, Clemens

AU - Voskuil, Michiel

AU - Kelder, Johannes

AU - Deneer, Vera

AU - Ten Berg, Jurriën M

PY - 2020/10/12

Y1 - 2020/10/12

N2 - There are no randomised data on which antiplatelet agent to use in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and an indication for oral anticoagulation (OAC). The randomised POPular Age trial, in patients of 70 years or older with NSTE-ACS, showed a reduction in bleeding without increasing thrombotic events in patients using clopidogrel as compared to ticagrelor. In this sub-analysis of the POPular AGE trial, we compare clopidogrel with ticagrelor in patients with a need for oral anticoagulation. The follow-up duration was one year. The primary bleeding outcome was Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding. The primary thrombotic outcome consisted of cardiovascular death, myocardial infarction and stroke. The primary net clinical benefit outcome was a composite of all-cause death, myocardial infarction, stroke, and PLATO major and minor bleeding. A total of 184/1011 (18.2%) patients on OAC were included in this subanalysis; 83 were randomized to clopidogrel and 101 to ticagrelor. The primary bleeding outcome was lower in the clopidogrel group (17/83, 20.9%) compared to the ticagrelor group (33/101, 33.5%; p = 0.051), as was the thrombotic outcome (7/83, 8.4% vs. 19/101, 19.2%; p = 0.035) and the primary net clinical benefit outcome (23/83, 27.7% vs. 49/101, 48.5%; p = 0.003). In this subgroup of patients using OAC, clopidogrel reduced PLATO major and minor bleeding compared to ticagrelor without increasing thrombotic risk. This analysis therefore suggests that, in line with the POPular Age trial, clopidogrel is a better option than ticagrelor in NSTE-ACS patients ≥70 years using OAC.

AB - There are no randomised data on which antiplatelet agent to use in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and an indication for oral anticoagulation (OAC). The randomised POPular Age trial, in patients of 70 years or older with NSTE-ACS, showed a reduction in bleeding without increasing thrombotic events in patients using clopidogrel as compared to ticagrelor. In this sub-analysis of the POPular AGE trial, we compare clopidogrel with ticagrelor in patients with a need for oral anticoagulation. The follow-up duration was one year. The primary bleeding outcome was Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding. The primary thrombotic outcome consisted of cardiovascular death, myocardial infarction and stroke. The primary net clinical benefit outcome was a composite of all-cause death, myocardial infarction, stroke, and PLATO major and minor bleeding. A total of 184/1011 (18.2%) patients on OAC were included in this subanalysis; 83 were randomized to clopidogrel and 101 to ticagrelor. The primary bleeding outcome was lower in the clopidogrel group (17/83, 20.9%) compared to the ticagrelor group (33/101, 33.5%; p = 0.051), as was the thrombotic outcome (7/83, 8.4% vs. 19/101, 19.2%; p = 0.035) and the primary net clinical benefit outcome (23/83, 27.7% vs. 49/101, 48.5%; p = 0.003). In this subgroup of patients using OAC, clopidogrel reduced PLATO major and minor bleeding compared to ticagrelor without increasing thrombotic risk. This analysis therefore suggests that, in line with the POPular Age trial, clopidogrel is a better option than ticagrelor in NSTE-ACS patients ≥70 years using OAC.

KW - non-ST-segment elevation myocardial infarction (NSTEMI)

KW - elderly

KW - non-vitamin K oral anticoagulation (NOAC)

KW - vitamin K antagonists (VKA)

KW - ticagrelor

KW - clopidogrel

U2 - 10.3390/jcm9103249

DO - 10.3390/jcm9103249

M3 - Article

C2 - 33053622

SN - 2077-0383

VL - 9

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 10

M1 - 3249

ER -

Gimbel ME, Tavenier AH, Bor W, Hermanides RS, de Vrey E, Heestermans T et al. Ticagrelor Versus Clopidogrel in Older Patients with NSTE-ACS Using Oral Anticoagulation: A Sub-Analysis of the POPular Age Trial. Journal of Clinical Medicine. 2020 Oct 12;9(10):3249. doi: 10.3390/jcm9103249