Background: There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population.Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age.Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results:Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 -0.614, p = 0.007). Conclusion:The use of a loading dose of clopidogrel (≥ 300 mg) in the population over 75 years of age is associated with higher bleeding rates.

Background: The transradial approach is currently the first option for percutaneous coronary procedures, whether diagnostic or therapeutic, particularly in patients with acute coronary syndromes. However, there is limited data in the literature comparing the use of a universal catheter from a radial approach versus the transfemoral approach. The purpose of this study was to demonstrate the feasibility of the single-catheter radial approach compared with the transfemoral approach. Methods: A retrospective assessment of cases of acute coronary syndrome undergoing invasive risk stratification and ad hoc percutaneous coronary intervention by transradial or transfemoral approach. In the transradial group, we selected cases in which one single guiding catheter was used in the procedure. Results: Between November 2011 and January 2013, we investigated 198 patients who met the selection criteria. Except for the higher mean age observed in the transradial group (63.5 vs. 59.2; p=0.002), there were no differences in clinical characteristics. In addition, there were no differences in clinical presentation, culprit vessel, number and size of the stents used, or final angiographic success rate. The number of vascular complications was higher, particularly hematomas <5cm, in the transfemoral group. Conclusion: The use of single-catheter transradial approach is feasible, safe and effective in managing patients with acute coronary syndrome.