Bleeding risk assessment in elderly patients with acute coronary syndrome
Lucía Riobóo-Lestón1, Sergio Raposeiras-Roubin1, Emad Abu-Assi1
1Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain.
Insights
Elderly patients face higher bleeding risks with dual antiplatelet therapy (DAPT) after acute coronary syndromes. New strategies are needed to manage bleeding risks in older adults, considering age-related factors and geriatric assessments.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Elderly individuals represent a growing population with increased risks of ischemic and bleeding events.
- Current acute coronary syndrome guidelines lack specific recommendations for aged patients due to limited evidence.
- Older patients (≥ 75 years) are underrepresented in clinical trials, necessitating tailored strategies.
Purpose of the Study:
- To evaluate the available evidence regarding bleeding risk in the elderly population.
- To identify age-related bleeding risk factors and the role of geriatric assessment.
- To explore strategies for reducing bleeding events in older patients undergoing antiplatelet therapy.
Main Methods:
- Review of current literature and clinical guidelines on antiplatelet therapy in the elderly.
- Analysis of bleeding risk scores and their predictive ability in older patients.
- Examination of factors influencing bleeding risk, including vascular access, drug choice, and duration of therapy.
Main Results:
- Existing bleeding risk scores show limited predictive accuracy in elderly populations.
- Vascular access choice, antiplatelet drug type, and duration are crucial for mitigating bleeding risk.
- Shorter dual antiplatelet therapy (DAPT) duration and radial approaches can reduce hemorrhage rates.
Conclusions:
- Strategies to reduce bleeding risk in elderly patients are urgently needed.
- Integral geriatric assessment and age-specific bleeding risk factors require further investigation.
- Alternative antithrombotic strategies, such as dual therapy with oral anticoagulation and a single antiplatelet, should be considered for high-risk patients.
Abstract:
Nowadays, elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events. Current acute coronary syndrome guidelines, strongly recommend dual antiplatelet therapy (DAPT) with few specific references for aged patients due to lack of evidence. Patients aged ≥ 75 years are misrepresented in the classic derivation trials cohorts. Strategies to reduce the bleeding risk in this group of patients are urgently needed for the daily clinical practice. Identify the specific age related bleeding risk factors and the importance of an integral geriatric assessment remains challenging. Some of the available in-hospital and out-hospital bleeding risk scores have shown a lower to moderate predictive ability in older patients and no specific tools are developed in elderly population. The importance of an appropriate vascular access choice, type and duration of antiplatelet drugs is crucial to reduce the bleeding risk. Increase radial approaches and short DAPT duration leads to reduce hemorrhages. One interesting subgroup of patients is those who need chronic anticoagulation therapy after percutaneous coronary intervention, due to their very high risk of bleeding. New alternatives as dual therapy with oral anticoagulation and only one antiplatlet drug should be considered. In current review, we evaluate the available evidence about bleeding risk in elderly.
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