IJCS | Volume 32, Nº5, September/October 2019

454 1. Mazhari R, Kapur N. Increased risk and increased reward in coronary intervention in older patients with acute coronary syndrome. Heart. 2014;100(19):1483-4. 2. Zaman MJ, Stirling S, Shepstone L, Ryding A, Flather M, Bachmann M, et al. The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP). Eur Heart J. 2014;35(23):1551-8. 3. Nicolau JC, Timerman A, Marin-Neto JA, Piegas LS, Barbosa CJDG, Franci A, et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST. Arq Bras Cardiol. 2014;102(3 Suppl.1):1-61. 4. 2012 Writing Committee Members, Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non– ST-elevation myocardial infarction (updating the 2007 guideline and References Soeiro et al. Clopidogrel in elderly patients Int J Cardiovasc Sci. 2019;32(5):449-456 Original Article appropriate pharmacological invasive treatment and the risk of bleeding and complications inherent to this age group. This study presents a change in bleeding rates that has a total correlation with the stance adopted by the guidelines. In spite of a greater number of ACS patients with ST-segment elevation and those undergoing PCI in the group who received clopidogrel loading dose, this study did not find any differences between the groups in relation to medications, performance of invasive procedures, number of radial vascular accesses and possible confounding variables adjusted for in the multivariate analysis. Still, bleeding remained as the independent and differential factor between the groups. Due to lack of strong evidence in this population, perhaps non-ST-segment ACS patients undergoing PCI in a range greater than 4 to 6 hours should receive doses less than 600 mg clopidogrel. Furthermore, it would be interesting and necessary to develop a randomized clinical trial to establish the best clinical therapy for the subgroup of patients aged over 75 years. Finally, the model of events prediction is hardly applicable to this population. The ideal would be to have a score which took into account frailty, dementia, level of dependence and other intrinsic characteristics of the elderly. 1,33,34 Limitations This is a retrospective study, with limited number of cases and a much greater number of patients in group I, compared to group II, since medication doses were administered according to the instructions of the doctor responsible for the case. Therefore, some more specific comparisons were not performed. Analysis of mortality and reinfarction cannot be inferred in this study. Nevertheless, we believe this study to be relevant, since guidelines are discordant and there is few data available in the literature on this issue. Conclusion The use of a loading dose of clopidogrel (≥ 300 mg) in the population over 75 years of age is associated with higher bleeding rates. Author contributions Conception and design of the research: Alexandre Soeiro, Guilherme Casale; Acquisition of data: Alexandre Soeiro, Guilherme Casale, Maria Antonieta A. A. M. Lopes, Lucas Colombo Godoy; Analysis and interpretation of the data: Aline Siqueira Bossa; Statistical analysis: Aline Siqueira Bossa; Writing of themanuscript: Alexandre Soeiro; Critical revision of the manuscript for intellectual content: Bruno Biselli, Tatiana C. A T. Leal, Maria Carolina F. A. Soeiro; Supervision / as the major investigador: Carlos V Serrano Jr., Múcio T. Oliveira Jr. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This study was approved by the Ethics Committee of the CAPPesq under the protocol number 881.656. All the procedures in this studywere in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.