Dual Antiplatelet Therapy in Patients Aged 75 years and Older with Coronary Artery Disease: A Meta-Analysis and Systematic Review.
DAPT in Elderly Patients with CAD
Authors: Garly Saint Croix, MD1, Spencer C. Lacy2, MD, MPH; Medeona Gjerdjindreaj MD1; Karthik Vedantam, MD1; Christian Torres, MD1 ;Malik Shehadeh, MD1 ; Nirat Beohar, MD1; Esteban Escolar, MD1
(1) Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida, USA
(2) Loyola University Medical Center, Maywood, Illinois, USA
All authors report no financial relationships or conflicts of interest regarding the contents of this paper.
This study is a meta-analysis on published data; therefore, no prior ethical approval was required.
Address for correspondence and reprint requests:
Name: Garly Saint Croix
Address: 4300 Alton Road, Miami Beach, FL 33140
Email:saintcroix.garly@gmail.com Phone: 786-812-6137
Total Word Count: 265
Keywords: dual antiplatelet therapy (DAPT), coronary artery disease (CAD), elderly
Abstract
Objectives: This systematic review and meta-analysis evaluates the safety and efficacy of dual antiplatelet therapy (DAPT) in patients aged 75 years and older after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
Background: The safety and efficacy of DAPT in elderly patients after PCI is not well characterized.
Methods: We performed a systematic literature review to identify clinical studies that reported safety and efficacy outcomes after DAPT for ACS in elderly patients. The primary outcomes of primary efficacy endpoint rates and bleeding event rates were reported as random effects risk ratio (RR) with 95% confidence interval. No prior ethical approval was required since all data is public.
Results: Our search yielded 660 potential studies. We included 9 studies reporting on 41,037 patients. There was a higher risk of bleeding event rates in elderly patients treated with DAPT when compared to aspirin and placebo with a risk ratio of 1.72 (95% CI 1.06 to 2.80, p = 0.03). There was a higher risk of bleeding event rates in elderly patients treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 1.17 (95% CI 1.04 to 1.31, p = 0.007). There was no difference in primary efficacy endpoint rates between elderly patients treated with DAPT when compared to aspirin and placebo with a risk ratio of 0.92 (95% CI 0.76 to 1.12, p = 0.41). There was no difference in primary efficacy endpoint rates between elderly patient treated with prasugrel or ticagrelor when compared to clopidogrel with a risk ratio of 0.85 (95% CI 0.67 to 1.09, p = 0.21).
Conclusions: This systematic review and meta-analysis suggests that DAPT is associated with a higher risk of bleeding events when compared to aspirin and placebo in patients aged 75 years and older with coronary artery disease. The use of prasugrel or ticagrelor is also associated with a higher risk of bleeding events when compared to clopidogrel in elderly patients with coronary artery disease. There was no difference in the primary efficacy endpoints between the two treatment groups.
