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Optimal dual antiplatelet therapy strategy in elderly patients with acute coronary syndrome

Monica Verdoia1, Rocco Gioscia1, Giuseppe De Luca1

  • 1Cardiologia e Unità Coronarica, Ospedale degli Infermi, ASL Biella, Italy; Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Università del Piemonte Orientale, Novara, Italy.

Journal of Geriatric Cardiology : JGC
|April 28, 2021
PubMed

Insights

Managing dual antiplatelet therapy (DAPT) in elderly patients with acute coronary syndrome (ACS) is complex due to increased risks. This review explores individualized DAPT strategies for better outcomes in older ACS patients.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Elderly patients constitute a significant proportion of acute coronary syndrome (ACS) hospitalizations.
  • Advanced age is associated with increased risks of both ischemic and hemorrhagic complications, complicating dual antiplatelet therapy (DAPT) management.
  • Current DAPT strategies require individualized approaches for elderly ACS patients.

Purpose of the Study:

  • To provide an updated overview of emerging evidence on DAPT management in elderly patients with ACS.
  • To review recent randomized clinical trials and subanalyses focusing on DAPT in this specific population.
  • To highlight individualized therapeutic options for DAPT in older adults post-ACS.

Main Methods:

  • Review of recent randomized clinical trials and subanalyses.
  • Analysis of emerging evidence on DAPT strategies in elderly ACS patients.
  • Focus on individualized approaches including dose-adjustment, early aspirin discontinuation, and tailored DAPT duration.

Main Results:

  • Several therapeutic options for DAPT duration and combination show promising safety and efficacy in elderly patients.
  • Individualized approaches such as dose-adjustment and early aspirin discontinuation are being explored.
  • Laboratory-driven tailoring and shorter or extended DAPT regimens are under investigation.

Conclusions:

  • Individualized DAPT strategies offer potential benefits for elderly patients with ACS.
  • Further validation is needed for criteria guiding the selection of optimal DAPT strategies in this population.
  • Emerging evidence suggests promising safety and efficacy for tailored DAPT in older adults post-ACS.

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