Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the praise registry

D’Ascenzo, Fabrizio; Filippo, Ovidio De; Manaï, R; Breviario, Susanna; Bruno, Francesco; Iannaccone, Mario; Wańha, Wojciech; Bianco, Matteo; Patti, Giuseppe; Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Bo, Mario; Ferrari, Gaetano Maria De; Conrotto, Federico

doi:10.1016/j.ijcard.2022.01.019

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…Due to the increased risk of bleeding associated with dual antiplatelet therapy in OHCA patients, we decided to exclude patients older than 70 years from the study design [6,36,37]. We did not observe a higher incidence of bleeding in the intervention group.…”

Section: Discussionmentioning

confidence: 99%

Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia

Kordis,

Berden,

Mikuz

et al. 2024

JCM

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Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and target temperature management (TTM) are at increased risk of stent thrombosis (ST), partly due to delayed platelet inhibition even with more potent P2Y12 agents. We hypothesized that periprocedural cangrelor would induce immediate platelet inhibition, bridging the “P2Y12 inhibition gap”. Methods: In our pilot study, we randomized 30 comatose OHCA patients undergoing PCI and TTM (32–34 °C) into cangrelor and control groups. Both groups received unfractioned heparin, acetylsalicylic acid, and ticagrelor via enteral tube. The cangrelor group also received an intravenous bolus of cangrelor followed by a 4 h infusion. Platelet inhibition was measured using VerifyNow® and Multiplate® ADP at baseline and 1, 3, 5, and 8 h post PCI. Results: Patient characteristics did not differ between groups. VerifyNow® showed significantly decreased platelet reactivity with cangrelor at 1 h (30 vs. 221 PRU; p < 0.001) and 3 h (24 vs. 180 PRU; p < 0.001), with differences at 5 and 8 h. Similarly, the proportion of patients with high on-treatment platelet reactivity (HPR) in the cangrelor group was significantly lower at 1 h (0% vs. 67%; p < 0.001) and 3 h (0% vs. 47%; p = 0.007). Multiplate® ADP was also decreased at 1 h (14 vs. 48 U; p < 0.001) and 3 h (11 vs. 42 U; p = 0.001), with no difference at 5 and 8 h. The occurrence of bleeding events was similar in both groups. Conclusions: Cangrelor safely induced immediate and profound platelet inhibition. We observed no significant drug–drug interaction with ticagrelor.

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Section: Discussionmentioning

confidence: 99%

Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia

Kordis,

Berden,

Mikuz

et al. 2024

JCM

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Clopidogrel or ticagrelor in elderly patients with acute coronary syndromes – Nihil nocere!

Schäfer

2022

International Journal of Cardiology

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Antiplatelet Strategies for Older Patients with Acute Coronary Syndromes: Finding Directions in a Low-Evidence Field

Servi

Landi

Savonitto³

et al. 2023

JCM

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Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the latest European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Recent data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. Under these circumstances, a de-escalation strategy seems reasonable, starting with DAPT that includes aspirin and low-dose prasugrel (a more potent and reliable P2Y12 inhibitor than clopidogrel) then switching after 2–3 months to DAPT with aspirin and clopidogrel for up to 12 months.

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Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the praise registry

Cited by 3 publications

References 27 publications

Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia

Immediate Platelet Inhibition Strategy for Comatose Out-of-Hospital Cardiac Arrest Survivors Undergoing Percutaneous Coronary Intervention and Mild Therapeutic Hypothermia

Clopidogrel or ticagrelor in elderly patients with acute coronary syndromes – Nihil nocere!

Antiplatelet Strategies for Older Patients with Acute Coronary Syndromes: Finding Directions in a Low-Evidence Field

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