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Antithrombotic Therapy for ACS in Elderly Patients

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Abstract

Background

Patients over 75 account for more than one third of those presenting with myocardial infarction and more than 50% of intrahospital mortality. There are no specific guidelines for the management of acute coronary syndromes (ACS) in the elderly.

Setting

Although antithrombotic therapy seems to be effective and safe in such patients, it requires specific precautions and treatment adjustments because of the higher bleeding risk due to comorbidities such as renal function impairment and malnutrition.

Results

Scientific evidence concerning elderly patients is scarce as they are either excluded or underrepresented in most randomized trials. Overall, the antithrombotic therapy needs to be adapted to avoid complications, mainly bleeding complications, without compromising the effectiveness of the treatment in this high-risk population.

Conclusion

In the present paper, we review the current treatment strategies in ACS while focusing on data concerning the elderly, according to available data in pivotal trials and in both AHA/ACC and ESC guidelines.

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Authors and Affiliations

  1. Department of Cardiology, CHU de Caen, F-14033, Caen, France

    Vincent Roule, Katrien Blanchart, Damien Legallois, Adrien Lemaitre, Paul Milliez, Farzin Beygui & Joachim Alexandre

  2. UNICAEN, CHU Caen, Signalisation, électrophysiologie et imagerie des lésions d’ischémie-reperfusion myocardique, Normandie Univ, 14000, Caen, France

    Vincent Roule, Xavier Humbert, Damien Legallois, Paul Milliez, Farzin Beygui & Joachim Alexandre

  3. Department of Cardiology, CHU de Caen, Avenue de la côte de nacre, 14000, Caen, France

    Vincent Roule

  4. UNICAEN, Department of General Medicine, Medical School, Normandie University, 14000, Caen, France

    Xavier Humbert

  5. Department of Pharmacology, CHU de Caen, F-14033, Caen, France

    Joachim Alexandre

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  1. Vincent Roule
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Contributions

VR, KB, XH, AL, DL and JA design and wrote the manuscript; PM and FB conceived and designed the manuscript. Literature and data extraction: VR, KB, XH, AL, DL and JA. Wrote the paper: VR, KB and JA. Proofreading and editing: PM and FB.

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Correspondence to Vincent Roule.

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Conflict of Interest

Dr. Alexandre has received research or educational grants to the institution from Bayer, Bristol-Myers Squibb, and Boehringer Ingelheim. Prof. Beygui has received institutional research grants and/or consultant honoraria from Medtronic, AstraZeneca, Biosensor, and Boston Scientific.

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Roule, V., Blanchart, K., Humbert, X. et al. Antithrombotic Therapy for ACS in Elderly Patients. Cardiovasc Drugs Ther 31, 609–618 (2017). https://doi.org/10.1007/s10557-017-6761-y

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