Antiplatelet therapy in elderly patients with acute coronary syndrome: Between scientific evidence and future perspectives

https://doi.org/10.4081/monaldi.2018.952

Authors

  • Francesco Barillà | francesco.barilla@uniroma1.it "Sapienza” University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Italy.
  • Concetta Torromeo "Sapienza” University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Italy.
  • Riccardo Iorio "Sapienza” University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Italy.
  • Luigina Porco "Sapienza” University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Italy.
  • Vincenzo Paravati "Sapienza” University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Italy.
  • Carlo Gaudio "Sapienza” University of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Italy.

Abstract

Dual antiplatelet therapy (DAPT) is an important strategy for reducing cardiovascular events (CV) after an acute coronary syndrome (ACS). Elderly patients undergoing DAPT have a higher risk of bleeding than younger patients for a variety of reasons. Stratification of thrombotic/hemorrhagic risk is mandatory in order to decide on the type and duration of DAPT. The percentage of patients ≥ 75 years represented in clinical trials is not large, so very often elderly people are prescribed treatment protocols only experimented on younger patients with a lower hemorrhagic risk. However, even in patients aged ≥ 75 treated with invasive or conservative therapy, after an ACS, a DAPT with aspirin 80-100 mg/day plus a P2Y12 receptor inhibitor for 12 months is recommended. In elderly patients, DAPT should be considered a dynamic process that can be modified over time based on the patient's clinical conditions, or any other necessities (non-procrastinating surgical interventions, comorbid-like effects that can increase hemorrhagic risk). In patients with moderate-high or very high hemorrhagic risk, DAPT treatment should last less than 12 months. A prolongation of DAPT beyond 12 months in this setting is limited to a very low percentage of patients, after careful assessment of ischemic/hemorrhagic profile.

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Published
2018-06-07
Info
Issue
Section
Cardiology - Original Articles
Keywords:
Acute coronary syndrome, dual antiplatelet therapy, elderly patients.
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  • PDF: 417
How to Cite
Barillà, Francesco, Concetta Torromeo, Riccardo Iorio, Luigina Porco, Vincenzo Paravati, and Carlo Gaudio. 2018. “Antiplatelet Therapy in Elderly Patients With Acute Coronary Syndrome: Between Scientific Evidence and Future Perspectives”. Monaldi Archives for Chest Disease 88 (2). https://doi.org/10.4081/monaldi.2018.952.

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