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Antithrombotic Pharmacotherapy in the Elderly: General Issues and Clinical Conundrums

  • Coronary Artery Disease (PH Stone, Section Editor)
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Opinion statement

Antithrombotic pharmacotherapy is an essential component in the pharmacologic arsenal of physicians dealing with diseases at high thromboembolic potential, such as coronary artery disease and atrial fibrillation. Age has a non-negligible impact on the pharmacokinetic and pharmacodynamic effects of antithrombotic medications. Although the benefits of antithrombotic pharmacotherapy in the elderly are well established, the elderly are generally more vulnerable to the adverse effects of antithrombotic drugs, particularly bleeding. Factors that may affect therapeutic agents in general (e.g., renal function, hepatic metabolism, body mass distribution) as well as factors more specific to thrombosis and hemostasis (e.g., platelet dysfunction, coagulation disorders) may partially account for such higher vulnerability, demanding careful consideration. The lack of studies performed specifically in the elderly and their under-representation in many large-scale clinical trials often lead guidelines to give neutral recommendations or even arbitrary assumptions. The development of novel antithrombotic agents with a more favorable safety profile may have a promising role in the ever-growing population of elderly individuals.

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Disclosure

D. Capodanno has received honoraria from Astrazeneca, Eli Lilly and Company. D.J. Angiolillo is a member of advisory boards for Bristol Myers Squibb; Sanofi-aventis, Eli Lilly and Company, Daiichi Sankyo, Inc., Astra Zeneca, The Medicines Company, Portola Pharmaceuticals, Novartis, Arena Pharmaceuticals, and Evolva Pharmaceuticals; has received research grants from Bristol Myers Squibb, Sanofi-aventis, Evolva, GlaxoSmithKline, Otsuka, Accumetrics, Eli Lilly and Company, Daiichi Sankyo, Inc., The Medicines Company, AstraZeneca, Eisai, Portola Pharmaceutical, Schering-Plough, and Johnson and Johnson; and has received honoraria from Bristol Myers Squibb, Sanofi-aventis, Eli Lilly and Company, Daiichi Sankyo, Inc.

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  1. University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Davide Capodanno MD & Dominick J. Angiolillo MD, PhD

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  1. Davide Capodanno MD
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  2. Dominick J. Angiolillo MD, PhD
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Correspondence to Dominick J. Angiolillo MD, PhD.

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Capodanno, D., Angiolillo, D.J. Antithrombotic Pharmacotherapy in the Elderly: General Issues and Clinical Conundrums. Curr Treat Options Cardio Med 14, 57–68 (2012). https://doi.org/10.1007/s11936-011-0153-6

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