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Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Clara Bonanad1,2,3, Francisca Esteve-Claramunt4, Sergio García-Blas1,2,5

  • 1Cardiology Department, Clinic University Hospital of Valencia, 46010 Valencia, Spain.

Journal of Clinical Medicine
|June 10, 2022
PubMed

Insights

Treating elderly patients with acute coronary syndrome (ACS) is challenging. This review examines oral antithrombotic therapy, dual antiplatelet therapy (DAPT), and atrial fibrillation (AF) strategies in older adults.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Elderly patients with acute coronary syndrome (ACS) present unique challenges in treatment due to specific population characteristics and limited evidence-based guidelines.
  • Optimal oral antithrombotic therapy in this demographic remains an area requiring further investigation and tailored recommendations.

Purpose of the Study:

  • To review current evidence on oral antithrombotic therapy for elderly patients with ACS.
  • To discuss dual antiplatelet therapy (DAPT) considerations and optimal strategies in this population.
  • To analyze antithrombotic approaches for elderly patients with atrial fibrillation (AF) and coronary artery disease (CAD).

Main Methods:

  • Systematic review of existing literature on antithrombotic therapy in elderly ACS patients.
  • Analysis of studies comparing DAPT regimens in older adults.
  • Examination of evidence regarding anticoagulation in elderly patients with comorbid AF and CAD.

Main Results:

  • Elderly ACS patients often have different responses and risks associated with antithrombotic therapies compared to younger populations.
  • Specific data on DAPT effectiveness and safety in the elderly ACS population is scarce, necessitating careful consideration of individual risk factors.
  • Management strategies for elderly patients with AF and CAD require a nuanced approach, balancing bleeding risk with thrombotic prevention.

Conclusions:

  • There is a critical need for more real-world data and geriatric-specific studies to guide antithrombotic treatment decisions in elderly patients with ACS and AF.
  • Personalized antithrombotic strategies are essential, considering the unique physiological and clinical profiles of older adults.
  • Further research is imperative to optimize the management of these complex patients and address remaining clinical questions.

Keywords:
acute coronary syndromeantiplatelet therapyclopidogrelelderlyprasugrelticagrelor

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