Which statement best reflects Beers Criteria guidance on prasugrel and ticagrelor use in adults aged 75 years or older?

• A. They increase the risk of major bleeding compared with clopidogrel, especially in adults 75 and older; if prasugrel is used, consider a lower dose (5 mg) for those 75 and older.
• B. They have no impact on bleeding risk in older adults.
• C. They should be used routinely without dose adjustment in older adults.
• D. They are contraindicated in all older adults.

Answer: (A)

Beers Criteria flags that prasugrel and ticagrelor carry a higher risk of major bleeding in older adults compared with clopidogrel, and this risk is especially pronounced in those aged 75 and older. Because of that heightened bleeding risk, if prasugrel is considered for someone in this age group, a lower dose of 5 mg is recommended to help mitigate harm. Ticagrelor also requires careful consideration in older patients due to bleeding risk, rather than routine use without adjustment. The other statements imply no difference in bleeding risk, routine use without dose changes, or a blanket contraindication for all older adults, which isn’t consistent with the guidance. The emphasis is on the increased bleeding risk in people 75 and older and the need for a reduced prasugrel dose if it’s used.