[Adverse events of dual antiplatelet therapy in patients over 75 years after acute myocardial infarction].

BACKGROUND

Acute coronary syndrome is one of the leading causes of morbidity and mortality in older adults. In patients aged ≥ 75 years, evidence regarding the safety of dual antiplatelet therapy (DAPT) is limited because these patients are frequently excluded from clinical trials and have a higher bleeding risk related to frailty and comorbidities.

OBJECTIVE

To evaluate the incidence of BARC 2, 3, or 5 bleeding events in patients aged ≥ 75 years with acute myocardial infarction according to DAPT duration (complete vs. abbreviated/interrupted).

METHODS

A retrospective observational cohort study was conducted in patients aged ≥ 75 years with acute coronary syndrome treated between January 2022 and December 2024. Patients were classified according to complete DAPT duration (12 months) or abbreviated/interrupted DAPT. Bleeding events were analyzed using the BARC classification, along with major adverse cardiovascular events. Relative risks (RR) with 95% confidence intervals (95% CI) were calculated, and multivariate logistic regression analysis was performed.

RESULTS

Eighty patients were included, with a mean age of 80 ± 4 years. The overall incidence of bleeding events was 77.5%. No significant differences were found between complete and abbreviated/interrupted DAPT regarding bleeding events (RR: 1.07; 95% CI: 0.77-1.49; p = 0.668). In multivariate analysis, DAPT duration was not independently associated with bleeding events. Most bleeding events were of low severity.

CONCLUSIONS

In this cohort of patients aged ≥ 75 years with acute coronary syndrome, bleeding events were highly frequent but generally mild, with no significant differences between complete and abbreviated/interrupted DAPT.