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The Elderly

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					In OASIS: Fundaprinox. Elderly (>65yo subgrp) demonstrated a nonsignificant benefit favoring fondaparinux, whereas the younger subgroup demonstrated a nonsignificant benefit favoring enoxaparin for the combination end point of death, MI, or refractory ischemia. Both subgroups did significantly better with regard to safety (major bleeding) with fondaparinux; however, the elderly subgroup demonstrated a greater (50.9%) relative risk reduction in bleeding with fondaparinux (2.7% versus 5.5% with enoxaparin) compared with younger patients who had a 33.3% relative risk reduction (1.4% versus 2.1% with enoxaparin). TACTICS-TIMI 18: Assigned patients to early invasive or conservative strategy. Patients also received treatment with aspirin, heparin, and tirofiban. At 6 months, the primary composite end point of death, MI, or rehospitalization was lower in the invasive arm than in the conservative arm (15.9% versus 19.4%, P=0.026). An age subgroup analysis from this trial described the benefits and risks in the elderly. In this analysis, a substantial treatment effect in favor of an invasive strategy for the reduction of death or MI was observed with advancing age (Figure 7). Compared with younger patients, the early invasive strategy yielded a greater absolute (4.1% versus 1%) and relative (42% versus 20.4%) risk reduction in death or MI at 30 days in the sbgrp 65 yo. For 75yo and older the absolute (10.8%) and relative (56%) reduction in death or MI with the early invasive strategy was even greater (event rates: 10.8% versus 21.6%, P=0.02). Source: Acure Coronary Care in the Elderly 'early invasive vs ischemiaguided strategy'.


				
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posted:9/21/2008
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