Ticagrelor or Prasugrel Versus Clopidogrel in Elderly Patients With an Acute Coronary Syndrome and a High Bleeding Risk: Optimization of Antiplatelet Treatment in High-risk Elderly

Inclusion Criteria: * At least 70 years of age. * Hospitalization for NSTEMI or UA \< 72 hours Exclusion Criteria: * Contraindication to P2Y12 inhibitors i.e. clopidogrel, prasugrel or ticagrelor: * Unable or unwilling to give informed consent or have a life expectancy of less than one year. * Having received thrombolytic therapy within the previous 24 hours. * Severe renal function impairment needing dialysis. * Confirmed or persistent severe hypertension (Systolic Blood Pressure (SBP) \> 180 mmHg and/or Diastolic Blood Pressure (DBP) \>110 mmHg) at randomization. * At increased bleeding risk, at the investigator's opinion, e.g. because of malignancy. * Cardiogenic shock (SBP ≤ 80mmHg for \>30 mins) or Intra-Aortic Balloon Pump (IABP) at the time of screening. * History of major surgery, severe trauma, fracture or organ biopsy within 90 days prior to randomisation. * Clinically significant out of range values for platelet count or haemoglobin at screening, in the investigator's opinion. * ACS under dual antiplatelet therapy, e.g. aspirin with a P2Y12 inhibitor; clopidogrel, prasugrel, ticagrelor. * Patients with a known CYP2C19 genotype at the time of randomization.