title: Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70 years and older--rationale and design of the POPular AGE study.
abstract: BACKGROUND
  Dual antiplatelet therapy with acetylsalicylic acid in combination with a more potent P2Y12- inhibitor (ticagrelor or prasugrel) is recommended in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) to prevent atherothrombotic complications. The evidence on which this recommendation is based shows that ticagrelor and prasugrel reduce atherothrombotic events at the expense of an increase in bleeding events when compared with clopidogrel. However, it remains unclear whether ticagrelor or prasugrel has a better net clinical benefit in elderly patients with NSTE-ACS when compared with clopidogrel. The POPular AGE trial is designed to address the optimal antiplatelet strategy in elderly NSTE-ACS patients.
  
  
  METHODS
  POPular AGE is a multicenter, open-label, randomized controlled trial that aims to include 1000 patients ≥70years of age with NSTE-ACS. Patients are randomly assigned to receive either clopidogrel or a more potent P2Y12 inhibitor (ticagrelor or prasugrel). The first primary end point is any bleeding event requiring medical intervention. The second primary end point is the net clinical benefit, a composite of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, "PLATelet inhibition and patient Outcomes" major bleeding, or "PLATelet inhibition and patient Outcomes" minor bleeding. Patients will be followed for 1 year after randomization, and analyses will be performed on the basis of intention to treat.
  
  
  CONCLUSIONS
  The POPular AGE is the first randomized controlled trial that will assess whether the treatment strategy with clopidogrel will result in fewer bleeding events without compromising the net clinical benefit in patients ≥70years of age with NSTE-ACS when compared with a treatment strategy with ticagrelor or prasugrel.
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
authors.forename: Khalid
authors.initials: K
authors.lastname: Qaderdan
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
authors.forename: Maycel
authors.initials: M
authors.lastname: Ishak
authors.affiliation: Medical Center Alkmaar, Department of Cardiology, Alkmaar, the Netherlands.
authors.forename: Antonius A C M
authors.initials: AA
authors.lastname: Heestermans
authors.affiliation: Meander Medical Center, Department of Cardiology, Amersfoort, the Netherlands.
authors.forename: Evelyn
authors.initials: E
authors.lastname: de Vrey
authors.affiliation: Leiden University Medical Center, Department of Cardiology, Leiden, the Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: University Medical Center Utrecht, Department of Cardiology, Division Heart & Lungs, Utrecht, the Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
authors.affiliation: Radboud University Medical Center, Department of Cardiology, Nijmegen, the Netherlands.
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
authors.affiliation: Isala, Department of Cardiology, Zwolle, the Netherlands.
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van't Hof
authors.affiliation: Gelre Hospital, Department of Cardiology, Apeldoorn, the Netherlands.
authors.forename: Björn E
authors.initials: BE
authors.lastname: Groenemeijer
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
authors.forename: Gerrit-Jan A
authors.initials: GJ
authors.lastname: Vos
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
authors.forename: Paul W A
authors.initials: PW
authors.lastname: Janssen
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Bergmeijer
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.affiliation: St. Antonius Hospital, Department of Clinical Pharmacy, Nieuwegein, the Netherlands.
authors.forename: Vera H M
authors.initials: VH
authors.lastname: Deneer
authors.affiliation: St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands. Electronic address: jurtenberg@gmail.com.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000368:Aged; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D012189:Retrospective Studies; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine