Takeaway
- Single antiplatelet therapy with aspirin showed comparable protective effect as dual antiplatelet therapy (DAPT) in very elderly patients who were medically managed after acute myocardial infarction (AMI).
- A clopidogrel only strategy, however, was associated with a higher risk for all-cause death.
Why this matters
- Frail and vulnerable elderly patients were not included in the clinical trials.
- The effect of different anti-platelet strategies in medically managed elderly patients with AMI remains unclear.
Study design
- Study of 1469 patients (age >80 years) with incident ST-elevation myocardial infarction (STEMI, 14%) or non-STEMI (86%).
- 390 patients received DAPT, 549 aspirin-only, and 530 clopidogrel-only.
- Study outcomes: all-cause death, cardiovascular death and gastrointestinal bleeding.
- Funding: Ministry of Health and Welfare, Taiwan.
Key results
- Both aspirin-only and DAPT groups showed similar risk for all-cause death (aHR, 1.20; P=.42), cardiovascular death (aHR, 1.16; P=.60) and gastrointestinal bleeding (aHR, 1.66; P=.20).
- Patients treated with clopidogrel vs DAPT had:
- higher risk for all-cause death (aHR, 1.50; P=.049),
- comparable risks for cardiovascular death (aHR, 1.13; P=.65) and gastrointestinal bleeding (aHR, 0.96; P=.92).
Limitations
- Nonrandomised study.
References
References
