Comparison of clinical efficacy and bleeding risk between ticagrelor and clopidogrel in elderly patients after percutaneous coronary intervention: A retrospective study

This study aims to compare the clinical efficacy and bleeding risk of ticagrelor and clopidogrel in elderly patients after percutaneous coronary intervention (PCI). A retrospective analysis was performed on 161 elderly patients (aged ≥65 years) who underwent PCI at our hospital between June 2022 and June 2024. Patients were divided into a ticagrelor group (TG; n = 82) and a clopidogrel group (CG; n = 79) based on their postoperative antiplatelet therapy regimen. Baseline clinical data were compared between the 2 groups. The patients were followed up for 12 months. The primary outcome measure was the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, acute myocardial infarction, ischemic stroke, and unplanned revascularization. Secondary outcomes included bleeding events (classified according to the Bleeding Academic Research Consortium criteria), stent-related events, platelet function parameters, adverse drug reactions, and quality of life scores (SF-36 scale). Logistic regression analysis was performed to identify factors associated with MACE. The overall bleeding event rate was higher in the TG than that in the CG (18.29% vs 7.59%, P = .053), with most cases classified as mild-to-moderate bleeding. The overall incidence of stent thrombosis was lower in the TG than in the CG (1.22% vs 5.06%, P = .203). Subgroup analyses indicated that ticagrelor showed a trend toward reducing MACE in patients with both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Platelet function tests showed that the platelet aggregation rates in the TG were significantly lower than those in the CG at 24 hours and 7 days after surgery (P < .05). Regarding adverse drug reactions, the incidence of dyspnea was significantly higher in the TG than that in the CG (13.41% vs 2.53%, P < .05). Multivariable logistic regression analysis showed that increasing age (odds ratio = 1.075, 95% confidence interval [CI]: 1.011-1.142, P = .028) and a history of myocardial infarction (odds ratio = 2.981, 95% CI: 1.032-8.712, P = .046) were independent risk factors for MACE. In elderly patients undergoing PCI, ticagrelor demonstrates a potential advantage over clopidogrel in preventing MACE, with stronger platelet inhibition and lower rates of stent thrombosis; however, this benefit is accompanied by a higher risk of bleeding and adverse reactions, such as dyspnea.