Cover Image

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

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

Keywords

Acute coronary syndrome; dual antiplatelet therapy; elderly patients.

Full Text:

PDF
Submitted: 2018-04-24 12:47:55
Published: 2018-06-07 14:54:31
Search for citations in Google Scholar
Related articles: Google Scholar
Abstract views:
2338

Views:
PDF
85

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


Copyright (c) 2018 Francesco Barillà, Concetta Torromeo, Riccardo Iorio, Luigina Porco, Vincenzo Paravati, Carlo Gaudio

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
 
© PAGEPress 2008-2018     -     PAGEPress is a registered trademark property of PAGEPress srl, Italy.     -     VAT: IT02125780185     •     Privacy