• Khalid Qaderdan, Maycel Ishak, Antonius A C M Heestermans, Evelyn de Vrey, J Wouter Jukema, Michiel Voskuil, Menko-Jan de Boer, Arnoud W J van't Hof, Björn E Groenemeijer, Gerrit-Jan A Vos, JanssenPaul W APWSt. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands., Thomas O Bergmeijer, Johannes C Kelder, Vera H M Deneer, and Jurriën M ten Berg.
• St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands.
• Am. Heart J. 2015 Nov 1; 170 (5): 981-985.e1.

RationaleDual 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.Study DesignPOPular 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.ConclusionThe 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.Copyright © 2015 Elsevier Inc. All rights reserved.

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