Guideline-based management of elderly patients with coexisting ACS, stroke, and AF requires individualized antithrombotic strategies to balance thrombotic and hemorrhagic risks.
This review synthesizes 2025 guideline recommendations for balancing thrombotic and hemorrhagic risks in elderly patients with concurrent ACS, stroke, and AF.
Abstract The concurrent presentation of acute coronary syndrome (ACS), acute ischemic stroke (AIS), and atrial fibrillation (AF) in elderly patients is a daunting clinical challenge, requiring careful balance between thrombotic and hemorrhagic risks. These conditions coexist due to overlapping pathophysiological mechanisms, which can complicate each disease process and influence the treatment approach. This review provides a 2025 update on guideline-based management strategies for this high-risk population, integrating the latest recommendations from the European Society of Cardiology, the European Stroke Organization, the American Heart Association, and the American Stroke Association. The discussion covers acute and long-term therapeutic strategies, with a focus on antithrombotic management, secondary prevention, and multidisciplinary care to achieve optimal patient outcomes. Attention is paid to critically analyzing notable guideline discrepancies, especially the duration of anticoagulation and dual antiplatelet therapy (DAPT). The review emphasizes the importance of individualized treatment strategies based on patient-specific risk profiles, addressing the evolving role of direct oral anticoagulants (DOACs) and emerging therapeutic options. This update also identified essential gaps in the current literature and indicated the need for future randomized controlled trials to optimize various treatment strategies. This review aims to synthesize contemporary evidence to enhance clinical decision-making and improve prognosis in elderly patients with these coexisting cardiovascular and cerebrovascular conditions.
Almutairi et al. (Fri,) conducted a review in Coexisting Acute Coronary Syndrome, Stroke, and Atrial Fibrillation. Guideline-based management strategies was evaluated. Guideline-based management of elderly patients with coexisting ACS, stroke, and AF requires individualized antithrombotic strategies to balance thrombotic and hemorrhagic risks.