Antithrombotic therapy in acute coronary syndrome: undertreatment of elderly?

  • Iacopo Muraca Cardiovascular Department, Careggi University Hospital, Florence, Italy. https://orcid.org/0000-0001-5861-5882
  • Francesca Ciatti Cardiovascular Department, Careggi University Hospital, Florence, Italy. https://orcid.org/0000-0001-6137-2631
  • Angela Migliorini Cardiovascular Department, Careggi University Hospital, Florence, Italy.
  • Niccolò Marchionni Cardiovascular Department, Careggi University Hospital, Florence, Italy.
  • Renato Valenti | renato.valenti2@tin.it Cardiovascular Department, Careggi University Hospital, Florence, Italy.

Abstract

The appropriate use of dual antiplatelet therapy (DAPT) in elderly patients with acute coronary syndrome (ACS) is largely debated. Due to the "demographic transition" in western countries, the elderly represent a growing percentage of patients admitted to hospitals for ACS, and among this high risk setting population most of early and late adverse outcomes occur. The presence of several concomitant “comorbidities” complicate the management strategy of both medical or invasive treatment and the clinical decision making process is challenging. Moreover, elderly people are constantly underrepresented in clinical trials and studies. As a result, there is no specific evidence about the optimal antithrombotic therapy in elderly and no specific recommendations are mentioned in the current ACS guidelines. Currently, the best practice for old people is still rudimentary and principally extrapolated from general cardiovascular guidelines. The management of elderly patients should be based on the evaluation of ischemic and hemorrhagic risk, life expectancy, comorbidities and parameters that are not included in the scores recommended by the current guidelines such as frailty and disability. In the era of “precision medicine”, the evaluation of bleeding and ischaemic risk in elderly patients must be a dynamic process because of the risk changing over time. A“tailored therapy by individualized medicine” is the key of management strategy.

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Published
2020-11-20
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Issue
Section
Cardiology - Reviews
Keywords:
Elderly, antithrombotic therapy, frailty, multimorbidity, acute coronary syndrome
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  • PDF: 9
How to Cite
Muraca, I., Ciatti, F., Migliorini, A., Marchionni, N., & Valenti, R. (2020). Antithrombotic therapy in acute coronary syndrome: undertreatment of elderly?. Monaldi Archives for Chest Disease, 90(4). https://doi.org/10.4081/monaldi.2020.1261