[Antiplatelet agents and older patients: which drugs and what evidence?]

Antiplatelet drugs are a cornerstone for the management of all atherosclerosis-related conditions, increasingly frequent with advanced age. Associations of antiplatelet drugs increase the bleeding risk and the overall net clinical benefit should be carefully assessed. In the absence of recommendations made specifically for the elderly practical suggestions can be inferred from subgroup analyses of large trials. The association of two antiplatelet agents should be limited to acute coronary syndromes for a maximum of one year, avoiding prasugrel in 75 years and older patients, and to coronary angioplasties for a minimum duration depending on the type of stent. In elderly patients with atrial fibrillation and ischemic heart disease more than one year after coronary stenting, a vitamin K antagonist alone is usually sufficient.