Key result
Antiplatelet therapy in elderly ACS patients requires tailored approaches to balance ischemic and bleeding risks.
Why the study?
Optimal antiplatelet therapy in very elderly ACS patients with comorbidities remains unclear due to safety and efficacy concerns, with heightened risks of both ischemic and bleeding events.
Management of antiplatelet therapy is particularly challenging in elderly and comorbid ACS patients due to the competing high risks of both ischemic and bleeding events.
Challenges standard regimens in elderly ACS; leaves open optimal individualized strategies for dedicated trials.
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.
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Rosa et al. (2019) conducted a review in Acute coronary syndrome. Antiplatelet therapy was evaluated. Antiplatelet therapy in elderly patients with acute coronary syndromes requires balancing increased ischemic and bleeding risks, highlighting the need for tailored therapeutic approaches.
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