TY - JOUR
T1 - Safety considerations with the use of platelet inhibitors for elderly patients with non-ST- elevation acute coronary syndrome
AU - Gimbel, M. E.
AU - Ten Berg, J. M.
N1 - Funding Information:
JM ten Berg reports lecture or consultancy fees from AstraZeneca, Eli Lilly, Daiichi Sankyo, The Medicines Company, AccuMetrics, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Bayer, Ferrer and Idorsia. He has received institutional research grants from ZonMw and AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021/12/2
Y1 - 2021/12/2
N2 - Introduction: Dual antiplatelet therapy (DAPT) is standard treatment for patients with acute coronary syndrome (ACS). This includes lifelong aspirin combined with a P2Y(12) inhibitor for 1 year. The indication for one of the P2Y(12) inhibitors (clopidogrel, prasugrel, ticagrelor) is dependent on the treatment strategy; whether patients undergo coronary angiography or are treated medically only. Tailoring antiplatelet therapy to the risk profile of the individual patient is of specific importance to the older patient. Areas covered: In this review, we discuss dual antiplatelet therapy in elderly patients with ACS. We present the options to tailor antiplatelet therapy based on platelet function testing, CYP2C19 genotyping and patients' thrombotic and bleeding risk. Finally, we discuss alternatives for dual antiplatelet therapy. Expert opinion: DAPT in elderly patients with ACS should consist of aspirin with clopidogrel or ticagrelor. Weighing patients' thrombotic and bleeding risk, based on clinical judgment or with use of specific risk scores, is probably the most convenient method to individualize antiplatelet therapy; however, CYP2C19 genotyping can also be used. In elderly patients with an increased bleeding risk, clopidogrel is a safe and effective alternative to ticagrelor. An alternative to 12 months DAPT could be ticagrelor monotherapy after a short period of DAPT.
AB - Introduction: Dual antiplatelet therapy (DAPT) is standard treatment for patients with acute coronary syndrome (ACS). This includes lifelong aspirin combined with a P2Y(12) inhibitor for 1 year. The indication for one of the P2Y(12) inhibitors (clopidogrel, prasugrel, ticagrelor) is dependent on the treatment strategy; whether patients undergo coronary angiography or are treated medically only. Tailoring antiplatelet therapy to the risk profile of the individual patient is of specific importance to the older patient. Areas covered: In this review, we discuss dual antiplatelet therapy in elderly patients with ACS. We present the options to tailor antiplatelet therapy based on platelet function testing, CYP2C19 genotyping and patients' thrombotic and bleeding risk. Finally, we discuss alternatives for dual antiplatelet therapy. Expert opinion: DAPT in elderly patients with ACS should consist of aspirin with clopidogrel or ticagrelor. Weighing patients' thrombotic and bleeding risk, based on clinical judgment or with use of specific risk scores, is probably the most convenient method to individualize antiplatelet therapy; however, CYP2C19 genotyping can also be used. In elderly patients with an increased bleeding risk, clopidogrel is a safe and effective alternative to ticagrelor. An alternative to 12 months DAPT could be ticagrelor monotherapy after a short period of DAPT.
KW - Antiplatelet therapy
KW - elderly
KW - non-ST elevation acute coronary syndrome
KW - percutaneous coronary intervention
KW - cyp2c19
KW - platelet function testing
KW - de-escalation
KW - DUAL ANTIPLATELET THERAPY
KW - OPEN-LABEL
KW - TICAGRELOR MONOTHERAPY
KW - ANTITHROMBOTIC THERAPY
KW - CARDIOVASCULAR EVENTS
KW - MYOCARDIAL-INFARCTION
KW - STENT IMPLANTATION
KW - EUROPEAN-SOCIETY
KW - BLEEDING EVENTS
KW - POSITION PAPER
U2 - 10.1080/14740338.2021.1936498
DO - 10.1080/14740338.2021.1936498
M3 - (Systematic) Review article
C2 - 34106029
SN - 1474-0338
VL - 20
SP - 1545
EP - 1552
JO - Expert opinion on drug safety
JF - Expert opinion on drug safety
IS - 12
ER -