Antiplatelet therapy in elderly patients with an acute coronary syndrome

This thesis investigated antiplatelet therapy in elderly patients with a heart attack. Antiplatelet therapy is crucial in the treatment of a heart attack and the prevention of a second one. A randomized comparison of antiplatelet therapy in elderly patients investigated the most effective and safest antiplatelet strategy. In addition, this thesis investigated antiplatelet treatment based on genotyping and reasons for early discontinuation of antiplatelet treatment. Results showed that there is no “one size fits all” antiplatelet strategy for elderly with a heart attack. However, in contrast with the total population of patients with a heart attack, in elderly patients, clopidogrel (the less potent platelet inhibitor) is a good alternative for ticagrelor (the more potent platelet inhibitor). Clopidogrel is better tolerated in elderly patients and is therefore less frequently prematurely discontinued than ticagrelor. Finally, choosing clopidogrel based on CYP2C19 genotyping (determination of genetic variations for the conversion of clopidogrel) appears to be as effective as based on age. With this thesis, the knowledge of antiplatelet therapy in elderly patients with a heart attack has been broadened; therefore, a more informed choice for a particular platelet inhibitor can be made.