Erika Lara-Pérez, Servicio de Cardiología Clínica, Hospital Juárez de México, Ciudad de México, México
Roberto Gallardo-Fernández, Servicio de Cardiología Clínica, CM ABC, Ciudad de México, México
Dulce T. Gutiérrez-Guadarrama, Servicio de Hemodinámica, Hospital Universitario Vall d’Hebron, Barcelona, España
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.
Keywords: Acute coronary syndrome. Myocardial infarction. Dual antiplatelet therapy. Hemorrhage. Elderly.
