Recommendation ID

What is the most clinically and cost-effective dual antiplatelet therapy for people aged 75 and over with an acute coronary syndrome, who are having percutaneous coronary intervention (PCI)? 

Any explanatory notes
(if applicable)
Why this is important

The evidence reviewed for this guideline found that prasugrel is the most clinically and cost-effective antiplatelet therapy when used with aspirin for the general acute coronary syndrome population having PCI, particularly for people with ST‑segment elevation myocardial infarction (STEMI). However, the summary of product characteristics for prasugrel states that its use in people aged 75 and over 'is generally not recommended and should only be undertaken with caution after a careful individual benefit/risk evaluation by the prescribing physician indicates that benefits in terms of prevention of ischaemic events outweigh the risk of serious bleedings'. There were not enough data available for this guideline to determine whether prasugrel is less effective, or even harmful, in people aged 75 and over. Further research is needed to determine the optimal dual antiplatelet therapy for this group of older people.

Source guidance details

Comes from guidance
Acute coronary syndromes
Date issued
November 2020

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 18/11/2020