Objective To investigate the efficacy and safety of ticagrelor in the treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the very old patients. Methods Consecutive senior NSTE-ACS patients (≥75 years old) admitted in our hospital from January 2014 to June 2015 were enrolled in this study. According to the anti-platelet strategies, the 202 subjects were divided into ticagrelor group (n=86, initially oral loading dose of 180 mg and then continue with 90 mg twice daily) and clopidogrel group (n=116, initially oral loading dose of 300 mg and then continue with 75 mg daily). All patients were followed up for 12 months after percutaneous coronary intervention (PCI) for the incidences of major adverse cardiac and cerebral events (MACCE), recurrent myocardial ischemia and bleeding events. Results MACCE occurred in obviously fewer patients of the ticagrelor group (4 cases/4.7%) than in the clopidogrel group (16 cases/13.8%, P=0.030). Recurrent myocardial ischemia was observed in 4 cases (4.7%) from the ticagrelor group, and in 8 cases (6.9%) out of the clopidogrel group, but there was no significant difference between them (P=0.495). There were 7 cases (8.1%) of bleeding events in the ticagrelor group, and 8 cases (6.8%) in the clopidogrel group, though without significant difference between them (P=0.752). Conclusion Ticagrelor treatment can improve the prognosis and has no effect in increasing the bleeding risk in the very old NSTE-ACS patients after undergoing PCI.