Antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes

作     者：Roberta De Rosa Federico Piscione Gennaro Galasso Stefano De Servi Stefano Savonitto 

作者机构：Department of MedicineSurgery and DentistrySchola Medica SalemitanaUniversity of SalernoItaly IRCCS MultimedicaSesto San Giovanni(MI)Italy Cardiovascular DepartmentAlessandro Manzoni HospitalLeccoItaly 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2019年第16卷第2期

页      面：103-113页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Acute coronary syndrome Antiplatelet therapy The elderly 

摘      要：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.