Objective The present study aimed to investigate the impact of early ticagrelor discontinuation (ETD) on clinical outcomes in the elderly patients (≥75) with acute coronary syndrome (ACS) or after percutaneous coronary intervention (PCI). Methods Recruited in the study were consecutive patients with ACS or after PCI treated with ticagrelor and aspirin in the Department of Cardiology of the Chinese PLA General Hospital from January 2014 to May 2016. The incidence and the reasons for ETD were recorded. Analysis was made of ETD (with 3 months of use), its reasons, and its influence on major ischemic events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, emergency revascularization, early stent thrombosis, late stent thrombosis) and major bleeding events [Bleeding Academic Research Consortium (BARC)≥ type 3] during a 1-year period. Results A total of 190 eligible elderly patients were recruited [age(78.7±3.6) years], of whom 65 (34.2%) discontinued ticagrelor early. Within a 12-month follow-up, the incidence of major ischemic events was significantly higher in the ETD patients than in those with continued ticagrelor treatment (13.8% vs 5.7%; HR=3.57,5%CI 1.15-11.09; P=0.03). No significant difference was found for the major bleeding events (1.5% vs 2.4%; HR=0.57,5%CI 0.05-6.00; P=0.64). Conclusion ETD within 3 months of medication in the elderly patients (≥75) with ACS or after PCI might increase the risk of major ischemic events.