Antiplatelet Therapy in Elderly Patients

Abstract

Age plays an essential role for the final decision of how to treat the individual patient after PCI. Elderly patients carry an increased risk of bleeding when taking anticoagulation or antiplatelet therapy or even a combination of both. Factors that may account for the enhanced bleeding risk are the higher incidence of comorbidities, frailty, low body weight, and the increased need for unplanned non-cardiac surgery. The choice of the antithrombotic therapy in elderly patients remains an ongoing challenge, because they – besides enhanced risk for bleeding – often require an even more intensified antithrombotic therapy as compared to younger patients. The recommended duration of DAPT is a matter of an ongoing debate. It depends on several conditions, e.g., stent type (bare metal or drug-eluting stent), the individual angiographic result, clinical condition (elective stenting versus stenting in ACS), as well as additional individual patient characteristics (e.g., age, history of bleeding). The current international guidelines of the European Society of Cardiology (ESC) recommend all patients with ACS to initially get ASA at an oral loading dose of 150–300 mg (or 80–150 mg i.v.) and a maintenance dose of 75–100 mg daily longterm regardless of the treatment strategy (IA) (Kolh and Windecker, Eur Heart J 35(46):3235–3236, 2014). In addition to ASA, a P2Y12 receptor antagonist should be started and maintained over a period of 12 months unless there are contraindications such as excessive bleeding.