Antiplatelet therapy for elderly patients with Acute Coronary Syndromes

Savonitto, Stefano; Morici, Nuccia; Servi, Stefano De

doi:10.18632/aging.101553

Cited by 3 publications

(3 citation statements)

References 8 publications

(8 reference statements)

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“…In patients after ACS undergoing PCI, standard 12 months dual antiplatelet therapy (DAPT) (aspirin plus P2Y12-receptor inhibitors) is usually recommended [ 60 ] aiming at reducing 1-year atherothrombotic events [ 67 ]. Both DAPT duration and powerful of P2Y12-inhibitor can impact on bleeding risk [ 68 ]. Data from a meta-analysis exploring 10 trials ( n = 32,287 patients undergoing PCI) showed that short DAPT, compared to standard 12 months therapy, significantly reduces major bleeding (OR: 0.58, 95% CI: 0.36–0.92) without increasing ischemic and thrombotic risk outcomes of myocardial infarction odds: 0.53 (0.42–0.66; p < 0.001) and stent thrombosis odds: 0.33 (0.21–0.51; p < 0.001), independent of P2Y12-inhibitor used [ 69 ].…”

Section: Frail Elderly Patients With Acs: the Dilemma Of Balancing Atherothrombotic And Bleeding Riskmentioning

confidence: 99%

“…Elderly population is often underrepresented in ACS trials and DAPT standard duration of 12 months has been largely discussed in recent years, especially in frail elderly population [ 68 ]. In fact, frailty has been associated to in-hospital bleeding [ 71 ] and predicts major bleeding within 30-day follow-up to discharge increasing all-cause mortality [ 72 ].…”

Section: Frail Elderly Patients With Acs: the Dilemma Of Balancing Atherothrombotic And Bleeding Riskmentioning

confidence: 99%

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Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation

Giallauria

Lorenzo

Venturini³

et al. 2021

JCM

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Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual’s clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.

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Section: Frail Elderly Patients With Acs: the Dilemma Of Balancing Atherothrombotic And Bleeding Riskmentioning

confidence: 99%

Section: Frail Elderly Patients With Acs: the Dilemma Of Balancing Atherothrombotic And Bleeding Riskmentioning

confidence: 99%

Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation

Giallauria

Lorenzo

Venturini³

et al. 2021

JCM

View full text Add to dashboard Buy / Rent full text

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“…This approach indeed applies to all patients, irrespective of their age, but it is clear that elderly subjects represent a unique group, given their increased risk of adverse events as well as complications, their frequent comorbidities, and their suboptimal compliance and adherence to prescribed regimens (13,14). Most importantly, elderly patients (especially when focusing on those older than 75 or more) are typically underrepresented in clinical trials, thus requiring complex decision making based on extrapolation when planning the best antiplatelet therapy regimen before, during and after percutaneous coronary intervention (15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review

Biondi-Zoccai

Antonazzo²,

Giordano³

et al. 2020

J Thorac Dis

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Percutaneous coronary intervention has become a mainstay in the management of coronary artery disease. While initially advanced age was considered a relative contraindication to invasive management of coronary artery disease, current cardiovascular practice stands solidly on an early invasive approach for elderly patients, typically based on radial access and drug-eluting stent implantation. Since the advent of coronary stents, oral antiplatelet therapy has proved crucial to maximize the benefits and minimize the risks of stenting, and this holds even truer in older patients rather than in younger ones.Indeed, the elderly is typically at higher risk of thrombotic events as well as bleeding complications, and thus careful decision making must be exercised to prescribe the most appropriate antiplatelet regimen. We thus conducted an umbrella review with scoping purposes on oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention, retrieving 8 pertinent systematic reviews. We found that, while several drugs are available, ranging from aspirin to cilostazol, clopidogrel, dipyridamole, prasugrel, ticagrelor, and ticlopidine, most commonly a dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor is recommended, with subtle adjustments for pretreatment, loading, dose, duration, escalation or de-escalation, with the potential adjunct in selected patients of novel oral anticoagulants. Indeed, a flexible and individualized approach to oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention is paramount, factoring patient features (exploiting thrombotic, bleeding and frailty scores), triage (including when appropriate non-invasive assessment of anatomic and functional significance of coronary artery disease), angiographic and other invasive imaging features, interventional technique, stent choice, rehabilitation, and secondary prevention.

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Antiplatelet therapy for elderly patients with Acute Coronary Syndromes

Cited by 3 publications

References 8 publications

Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation

Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation

Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review

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