Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

doi:10.3390/jcm11113008

Review

. 2022 May 26;11(11):3008.

doi: 10.3390/jcm11113008.

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Clara Bonanad^{1

2

3}, Francisca Esteve-Claramunt⁴, Sergio García-Blas^{1

2

5}, Ana Ayesta⁶, Pablo Díez-Villanueva⁷, Jose-Ángel Pérez-Rivera⁸, José Luis Ferreiro^{5

9}, Joaquim Cánoves^{1

2

3}, Francisco López-Fornás^{1

2

3}, Albert Ariza Solé⁸, Sergio Raposerias¹⁰, David Vivas¹¹, Regina Blanco¹², Daznia Bompart Berroterán³, Alberto Cordero^{5

13}, Julio Núñez^{1

2

3

5}, Lorenzo Fácila¹⁴, Iván J Núñez-Gil¹¹, José Luis Górriz^{2

3

15}, Vicente Bodí^{1

2

3

5}, Manuel Martínez-Selles¹⁶, Juan Miguel Ruiz Nodar¹⁷, Francisco Javier Chorro^{1

2

3

5}

Affiliations

¹ Cardiology Department, Clinic University Hospital of Valencia, 46010 Valencia, Spain.
² INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
³ Department of Medicine, University of Valencia, 46010 Valencia, Spain.
⁴ Department of Nursing, Faculty of Health Sciences, European University of Valencia, 46010 Valencia, Spain.
⁵ Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain.
⁶ Cardiology Department, Central University Hospital of Asturias, 33011 Oviedo, Spain.
⁷ Cardiology Department, La Princesa University Hospital, 28006 Madrid, Spain.
⁸ Cardiology Department, University Hospital of Burgos, Isabel I University, 09003 Burgos, Spain.
⁹ Cardiology Department, Bellvitge University Hospital, 08907 Barcelona, Spain.
¹⁰ Cardiology Department, Álvaro Cunqueiro University Hospital, 36213 Vigo, Spain.
¹¹ Department of Medicine, Cardiovascular Institute, San Carlos University Hospital, Complutense University, 28040 Madrid, Spain.
¹² Cardiology Department, Quirónsalud Hospital of Valencia, 46010 Valencia, Spain.
¹³ Cardiology Department, San Juan University Hospital, 00921 Alicante, Spain.
¹⁴ Cardiology Department, General University Hospital of Valencia, 46014 Valencia, Spain.
¹⁵ Department of Nephrology, Clinic University Hospital of Valencia, 46010 Valencia, Spain.
¹⁶ Cardiology Department, Hospital Universitario Gregorio Marañón, Universidad Europea, Complutense University, 28040 Madrid, Spain.
¹⁷ Servicio de Cardiología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, CIBER-CV, 03010 Alicante, Spain.

PMID: 35683397
PMCID: PMC9181473
DOI: 10.3390/jcm11113008

Review

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Clara Bonanad et al. J Clin Med. 2022.

. 2022 May 26;11(11):3008.

doi: 10.3390/jcm11113008.

Authors

Affiliations

¹ Cardiology Department, Clinic University Hospital of Valencia, 46010 Valencia, Spain.
² INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
³ Department of Medicine, University of Valencia, 46010 Valencia, Spain.
⁴ Department of Nursing, Faculty of Health Sciences, European University of Valencia, 46010 Valencia, Spain.
⁵ Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain.
⁶ Cardiology Department, Central University Hospital of Asturias, 33011 Oviedo, Spain.
⁷ Cardiology Department, La Princesa University Hospital, 28006 Madrid, Spain.
⁸ Cardiology Department, University Hospital of Burgos, Isabel I University, 09003 Burgos, Spain.
⁹ Cardiology Department, Bellvitge University Hospital, 08907 Barcelona, Spain.
¹⁰ Cardiology Department, Álvaro Cunqueiro University Hospital, 36213 Vigo, Spain.
¹¹ Department of Medicine, Cardiovascular Institute, San Carlos University Hospital, Complutense University, 28040 Madrid, Spain.
¹² Cardiology Department, Quirónsalud Hospital of Valencia, 46010 Valencia, Spain.
¹³ Cardiology Department, San Juan University Hospital, 00921 Alicante, Spain.
¹⁴ Cardiology Department, General University Hospital of Valencia, 46014 Valencia, Spain.
¹⁵ Department of Nephrology, Clinic University Hospital of Valencia, 46010 Valencia, Spain.
¹⁶ Cardiology Department, Hospital Universitario Gregorio Marañón, Universidad Europea, Complutense University, 28040 Madrid, Spain.
¹⁷ Servicio de Cardiología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, CIBER-CV, 03010 Alicante, Spain.

PMID: 35683397
PMCID: PMC9181473
DOI: 10.3390/jcm11113008

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.

Keywords: acute coronary syndrome; antiplatelet therapy; clopidogrel; elderly; prasugrel; ticagrelor.

PubMed Disclaimer

Conflict of interest statement

D.V. reports scientific consulting with AstraZeneca, Bayer, Lilly, Boehringer-Ingelheim, Daichii-Sankyo, and Pfizer-BMS. C.B. reports scientific consulting with AstraZeneca, Bayer, Lilly, Boehringer-Ingelheim, Daichii-Sankyo, and Pfizer-BMS. JLF reports (a) honoraria for lectures from Eli Lilly Co., Daiichi Sankyo, Inc., AstraZeneca, Roche Diagnostics, Pfizer, Abbott, Ferrer, Boehringer Ingelheim, Bristol-Myers Squibb, and Rovi; (b) consulting fees from AstraZeneca, Eli Lilly Co., Ferrer, Boston Scientific, Pfizer, Boehringer Ingelheim, Daiichi Sankyo, and Bristol-Myers Squibb; (c) research grants from AstraZeneca. J.N. reports personal fees from AstraZeneca, Novartis, Boehringer-Ingelheim, Eli Lilly Co., Rovi, NovoNordisk, and Vifor Pharma. S.R.R. reports scientific consulting with AstraZeneca, Amgen, Bayer, Boehringer-Ingelheim, Daichii-Sankyo, and Pfizer-BMS.

Cited by

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, Gullón A. Bonanad C, et al. J Clin Med. 2022 Dec 14;11(24):7423. doi: 10.3390/jcm11247423. J Clin Med. 2022. PMID: 36556039 Free PMC article.
The Benefits of a Comprehensive Cardiac Rehabilitation Program for Patients with Acute Coronary Syndrome: A Follow-Up Study.
Craciun LM, Buleu F, Pah AM, Badalica-Petrescu M, Bodea O, Man DE, Cosor OC, Iurciuc S, Dragan S, Rada M. Craciun LM, et al. J Pers Med. 2023 Oct 21;13(10):1516. doi: 10.3390/jpm13101516. J Pers Med. 2023. PMID: 37888127 Free PMC article.
Non-ST Elevation Myocardial Infarction in the Elderly. Antithrombotic Therapy and Beyond.
Díez-Villanueva P, Jiménez-Méndez C, Ferreiro JL, Cepas-Guillén P, Bonanad C, García-Blas S, Ariza-Solé A, Sanchís J, Martínez-Sellés M. Díez-Villanueva P, et al. Rev Cardiovasc Med. 2023 Jul 13;24(7):201. doi: 10.31083/j.rcm2407201. eCollection 2023 Jul. Rev Cardiovasc Med. 2023. PMID: 39077013 Free PMC article. Review.
Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction.
Álvarez-Zaballos S, Juárez-Fernández M, Martínez-Sellés M. Álvarez-Zaballos S, et al. Rev Cardiovasc Med. 2024 Feb 28;25(3):78. doi: 10.31083/j.rcm2503078. eCollection 2024 Mar. Rev Cardiovasc Med. 2024. PMID: 39076933 Free PMC article. Review.

References

1. Luca L.D., Servi S.D., Musumeci G., Bolognese L. Is ticagrelor safe in octogenarian patients with non-ST elevation acute coronary syndromes? Eur. Heart J. Cardiovasc. Pharmacother. 2018;4:12–14. doi: 10.1093/ehjcvp/pvx034. - DOI - PubMed
1. Jiménez-Méndez C., Díez-Villanueva P., Alfonso F. Non-ST segment elevation myocardial infarction in the elderly. Rev. Cardiovasc. Med. 2021;22:779–786. doi: 10.31083/j.rcm2203084. - DOI - PubMed
1. Tantry U.S., Navarese E.P., Myat A., Chaudhary R., Gurbel P.A. Combination oral antithrombotic therapy for the treatment of myocardial infarction: Recent developments. Expert Opin. Pharmacother. 2018;19:653–665. doi: 10.1080/14656566.2018.1457649. - DOI - PubMed
1. Capranzano P., Angiolillo D.J. Tailoring P2Y12 Inhibiting Therapy in Elderly Patients with Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J. Am. Heart Assoc. 2019;8:e014000. doi: 10.1161/JAHA.119.014000. - DOI - PMC - PubMed
1. Andreotti F., Rocca B., Husted S., Ajjan R.A., Berg J.T., Cattaneo M., Collet J.P., De Caterina R., Fox K.A., Halvorsen S., et al. Antithrombotic therapy in the elderly: Expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur. Heart J. 2015;36:3238–3249. doi: 10.1093/eurheartj/ehv304. - DOI - PubMed

Publication types

Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

[1] Luca L.D., Servi S.D., Musumeci G., Bolognese L. Is ticagrelor safe in octogenarian patients with non-ST elevation acute coronary syndromes? Eur. Heart J. Cardiovasc. Pharmacother. 2018;4:12–14. doi: 10.1093/ehjcvp/pvx034. - DOI - PubMed

[2] Luca L.D., Servi S.D., Musumeci G., Bolognese L. Is ticagrelor safe in octogenarian patients with non-ST elevation acute coronary syndromes? Eur. Heart J. Cardiovasc. Pharmacother. 2018;4:12–14. doi: 10.1093/ehjcvp/pvx034. - DOI - PubMed

[3] Jiménez-Méndez C., Díez-Villanueva P., Alfonso F. Non-ST segment elevation myocardial infarction in the elderly. Rev. Cardiovasc. Med. 2021;22:779–786. doi: 10.31083/j.rcm2203084. - DOI - PubMed

[4] Jiménez-Méndez C., Díez-Villanueva P., Alfonso F. Non-ST segment elevation myocardial infarction in the elderly. Rev. Cardiovasc. Med. 2021;22:779–786. doi: 10.31083/j.rcm2203084. - DOI - PubMed

[5] Tantry U.S., Navarese E.P., Myat A., Chaudhary R., Gurbel P.A. Combination oral antithrombotic therapy for the treatment of myocardial infarction: Recent developments. Expert Opin. Pharmacother. 2018;19:653–665. doi: 10.1080/14656566.2018.1457649. - DOI - PubMed

[6] Tantry U.S., Navarese E.P., Myat A., Chaudhary R., Gurbel P.A. Combination oral antithrombotic therapy for the treatment of myocardial infarction: Recent developments. Expert Opin. Pharmacother. 2018;19:653–665. doi: 10.1080/14656566.2018.1457649. - DOI - PubMed

[7] Capranzano P., Angiolillo D.J. Tailoring P2Y12 Inhibiting Therapy in Elderly Patients with Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J. Am. Heart Assoc. 2019;8:e014000. doi: 10.1161/JAHA.119.014000. - DOI - PMC - PubMed

[8] Capranzano P., Angiolillo D.J. Tailoring P2Y12 Inhibiting Therapy in Elderly Patients with Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J. Am. Heart Assoc. 2019;8:e014000. doi: 10.1161/JAHA.119.014000. - DOI - PMC - PubMed

[9] Andreotti F., Rocca B., Husted S., Ajjan R.A., Berg J.T., Cattaneo M., Collet J.P., De Caterina R., Fox K.A., Halvorsen S., et al. Antithrombotic therapy in the elderly: Expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur. Heart J. 2015;36:3238–3249. doi: 10.1093/eurheartj/ehv304. - DOI - PubMed

[10] Andreotti F., Rocca B., Husted S., Ajjan R.A., Berg J.T., Cattaneo M., Collet J.P., De Caterina R., Fox K.A., Halvorsen S., et al. Antithrombotic therapy in the elderly: Expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur. Heart J. 2015;36:3238–3249. doi: 10.1093/eurheartj/ehv304. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Affiliations

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Authors

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous

Abstract

Conflict of interest statement

Similar articles

Cited by

References

Publication types

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous