Antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes
Roberta De Rosa1, Federico Piscione1, Gennaro Galasso1
1Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Italy.
Insights
Optimal antiplatelet therapy (APT) for older adults after acute coronary syndrome (ACS) is unclear. This review examines evidence and challenges for APT in elderly patients with ACS and comorbidities, balancing ischemic and bleeding risks.
Area of Science:
- Cardiology
- Geriatric Medicine
- Pharmacology
Background:
- Population ageing leads to more older adults experiencing acute coronary syndrome (ACS).
- Early revascularization benefits are established in elderly ACS patients.
- Optimal antiplatelet therapy (APT) in this demographic remains uncertain due to safety and efficacy concerns.
Purpose of the Study:
- To review current evidence on antiplatelet therapy (APT) in elderly patients with ACS.
- To identify knowledge gaps and ongoing research in APT for this population.
- To address challenges in managing APT due to age-related comorbidities and frailty.
Main Methods:
- Comprehensive literature review of randomized clinical trials and observational studies.
- Analysis of data concerning APT efficacy and safety in elderly ACS patients.
- Evaluation of factors influencing APT management, including comorbidities like CKD, diabetes, and frailty.
Main Results:
- Evidence supports early revascularization in elderly ACS patients.
- Optimal APT strategies are not well-defined, with concerns for both bleeding and ischemic events.
- Elderly patients exhibit increased vulnerability to drug toxicity and reduced therapeutic effects.
Conclusions:
- Managing APT in elderly ACS patients is complex due to heightened risks of ischemic and bleeding events.
- Further research is needed to establish optimal APT regimens for older adults with ACS and comorbidities.
- Personalized APT strategies are crucial for improving outcomes in this vulnerable population.
Abstract:
With population ageing and rise of life expectancy, a progressively increasing proportion of patients presenting with an acute coronary syndrome (ACS) are older adults, including those at extreme chronological age. Increasing amounts of data, including randomized clinical trials, have shown that the benefits of an early revascularization are maintained also at very old age, resulting in improved outcome after an acute coronary event. On the contrary, the optimal antiplatelet therapy (APT) remains unclear in these patients, because of both safety and efficacy concerns. Indeed, age-related multiple organ dysfunction and high prevalence of comorbidities may on the one hand reduce the therapeutic effects of administered drugs; on the other hand, it leads to increased vulnerability to drug toxicity and side effects. Therefore, management of APT is particularly challenging in elderly patients because of higher risk of both ischemic and bleeding events. The aim of the present paper is to review the current evidence, gaps in knowledge and ongoing research regarding APT in the setting of an ACS in elderly and very elderly patients, and in those with significant comorbidities including chronic kidney disease, diabetes mellitus and frailty.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...