Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Overview

Journal J Clin Med

Specialty General Medicine

Date 2022 Jun 10

PMID 35683397

Authors

Clara Bonanad

Francisca Esteve-Claramunt

Sergio Garcia-Blas

Ana Ayesta

Pablo Diez-Villanueva

Jose-Angel Perez-Rivera

Jose Luis Ferreiro

Joaquim Canoves

Francisco Lopez-Fornas

Albert Ariza Sole

Sergio Raposerias

David Vivas

Regina Blanco

Daznia Bompart Berroteran

Alberto Cordero

Julio Nunez

Lorenzo Facila

Ivan J Nunez-Gil

Jose Luis Gorriz

Vicente Bodi

Manuel Martinez-Selles

Juan Miguel Ruiz Nodar

Francisco Javier Chorro

Affiliations

Soon will be listed here.

Abstract

The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy in elderly patients. To this end, we discuss the peculiarities and differences reported referring to dual antiplatelet therapy (DAPT) in ACS management in elderly patients and what might be the best option considering these population characteristics. Furthermore, we analyze antithrombotic strategies in patients with atrial fibrillation (AF), with a particular focus on those cases that also present coronary artery disease (CAD). It is imperative to deepen our knowledge regarding the management of these challenging patients through real-world data and specifically designed geriatric studies to help resolve the questions remaining in their disease management.

Citing Articles

Non-ST Elevation Myocardial Infarction in the Elderly. Antithrombotic Therapy and Beyond.

Diez-Villanueva P, Jimenez-Mendez C, Ferreiro J, Cepas-Guillen P, Bonanad C, Garcia-Blas S Rev Cardiovasc Med. 2024; 24(7):201.

PMID: 39077013 PMC: 11266491. DOI: 10.31083/j.rcm2407201.

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction.

Alvarez-Zaballos S, Juarez-Fernandez M, Martinez-Selles M Rev Cardiovasc Med. 2024; 25(3):78.

PMID: 39076933 PMC: 11263832. DOI: 10.31083/j.rcm2503078.

The Benefits of a Comprehensive Cardiac Rehabilitation Program for Patients with Acute Coronary Syndrome: A Follow-Up Study.

Craciun L, Buleu F, Pah A, Badalica-Petrescu M, Bodea O, Man D J Pers Med. 2023; 13(10).

PMID: 37888127 PMC: 10608079. DOI: 10.3390/jpm13101516.

Oral Anticoagulant Use and Appropriateness in Elderly Patients with Atrial Fibrillation in Complex Clinical Conditions: ACONVENIENCE Study.

Bonanad C, Formiga F, Anguita M, Petidier R, Gullon A J Clin Med. 2022; 11(24).

PMID: 36556039 PMC: 9781896. DOI: 10.3390/jcm11247423.

References

Matoba T, Yasuda S, Kaikita K, Akao M, Ako J, Nakamura M . Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting: Insights From the AFIRE Trial. JACC Cardiovasc Interv. 2021; 14(21):2330-2340. DOI: 10.1016/j.jcin.2021.07.045. View

Szummer K, Montez-Rath M, Alfredsson J, Erlinge D, Lindahl B, Hofmann R . Comparison Between Ticagrelor and Clopidogrel in Elderly Patients With an Acute Coronary Syndrome: Insights From the SWEDEHEART Registry. Circulation. 2020; 142(18):1700-1708. DOI: 10.1161/CIRCULATIONAHA.120.050645. View

Motovska Z, Hlinomaz O, Miklik R, Hromadka M, Varvarovsky I, Dusek J . Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study. Circulation. 2016; 134(21):1603-1612. DOI: 10.1161/CIRCULATIONAHA.116.024823. View

Russo J, James T, Ruel M, Dupuis J, Singh K, Goubran D . Ischemic and bleeding outcomes after coronary artery bypass grafting among patients initially treated with a P2Y receptor antagonist for acute coronary syndromes: Insights on timing of discontinuation of ticagrelor and clopidogrel prior to surgery. Eur Heart J Acute Cardiovasc Care. 2018; 8(6):543-553. DOI: 10.1177/2048872617740832. View

Andreotti F, Rocca B, Husted S, Ajjan R, Berg J, Cattaneo M . Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2015; 36(46):3238-49. DOI: 10.1093/eurheartj/ehv304. View

Monelli M, Molteni M, Cassetti G, Bagnara L, De Grazia V, Zingale L . Non-vitamin K oral anticoagulant use in the elderly: a prospective real-world study - data from the REGIstry of patients on Non-vitamin K oral Anticoagulants (REGINA). Vasc Health Risk Manag. 2019; 15:19-25. PMC: 6378887. DOI: 10.2147/VHRM.S191208. View

Menichelli M, Neumann F, Ndrepepa G, Mayer K, Wohrle J, Bernlochner I . Age- and Weight-Adapted Dose of Prasugrel Versus Standard Dose of Ticagrelor in Patients With Acute Coronary Syndromes : Results From a Randomized Trial. Ann Intern Med. 2020; 173(6):436-444. DOI: 10.7326/M20-1806. View

Kulik A, Abreu A, Boronat V, Kouchoukos N, Ruel M . Impact of ticagrelor versus aspirin on graft patency after CABG: Rationale and design of the TARGET (ticagrelor antiplatelet therapy to reduce graft events and thrombosis) randomized controlled trial (NCT02053909). Contemp Clin Trials. 2018; 68:45-51. DOI: 10.1016/j.cct.2018.03.008. View

Yusuf S, Zhao F, Mehta S, Chrolavicius S, Tognoni G, Fox K . Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001; 345(7):494-502. DOI: 10.1056/NEJMoa010746. View

10.

Guerrero C, Ariza-Sole A, Formiga F, Martinez-Selles M, Vidan M, Aboal J . Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction. J Geriatr Cardiol. 2019; 15(12):713-717. PMC: 6330266. DOI: 10.11909/j.issn.1671-5411.2018.12.003. View

11.

Husted S, James S, Becker R, Horrow J, Katus H, Storey R . Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial. Circ Cardiovasc Qual Outcomes. 2012; 5(5):680-8. DOI: 10.1161/CIRCOUTCOMES.111.964395. View

12.

Bonanad C, Garcia-Blas S, Torres Llergo J, Fernandez-Olmo R, Diez-Villanueva P, Ariza-Sole A . Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Clin Med. 2021; 10(22). PMC: 8618042. DOI: 10.3390/jcm10225268. View

13.

Mehran R, Baber U, Sharma S, Cohen D, Angiolillo D, Briguori C . Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med. 2019; 381(21):2032-2042. DOI: 10.1056/NEJMoa1908419. View

14.

Schupke S, Neumann F, Menichelli M, Mayer K, Bernlochner I, Wohrle J . Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. N Engl J Med. 2019; 381(16):1524-1534. DOI: 10.1056/NEJMoa1908973. View

15.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

16.

De Luca L, De Servi S, Musumeci G, Bolognese L . Is ticagrelor safe in octogenarian patients with non-ST elevation acute coronary syndromes?. Eur Heart J Cardiovasc Pharmacother. 2017; 4(1):12-14. DOI: 10.1093/ehjcvp/pvx034. View

17.

Crea F, Thiele H, Sibbing D, Barthelemy O, Bauersachs J, Bhatt D . Debate: Prasugrel rather than ticagrelor is the preferred treatment for NSTE-ACS patients who proceed to PCI and pretreatment should not be performed in patients planned for an early invasive strategy. Eur Heart J. 2021; 42(31):2973-2985. DOI: 10.1093/eurheartj/ehab277. View

18.

Bruneau A, Schwab C, Anfosso M, Fernandez C, Hindlet P . Burden of Inappropriate Prescription of Direct Oral Anticoagulants at Hospital Admission and Discharge in the Elderly: A Prospective Observational Multicenter Study. Drugs Aging. 2019; 36(11):1047-1055. DOI: 10.1007/s40266-019-00710-8. View

19.

Lee S, Rhee T, Kang D, Choi E, Oh S, Lip G . Meta-Analysis of Oral Anticoagulant Monotherapy as an Antithrombotic Strategy in Patients With Stable Coronary Artery Disease and Nonvalvular Atrial Fibrillation. Am J Cardiol. 2019; 124(6):879-885. DOI: 10.1016/j.amjcard.2019.05.072. View

20.

Wallentin L, Becker R, Budaj A, Cannon C, Emanuelsson H, Held C . Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361(11):1045-57. DOI: 10.1056/NEJMoa0904327. View