Safety considerations with the use of platelet inhibitors for elderly patients with non-ST- elevation acute coronary syndrome

M. E. Gimbel*, J. M. Ten Berg

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Web of Science)

Abstract

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.

Original languageEnglish
Pages (from-to)1545-1552
Number of pages8
JournalExpert opinion on drug safety
Volume20
Issue number12
Early online date13 Jun 2021
DOIs
Publication statusPublished - 2 Dec 2021

Keywords

  • Antiplatelet therapy
  • elderly
  • non-ST elevation acute coronary syndrome
  • percutaneous coronary intervention
  • cyp2c19
  • platelet function testing
  • de-escalation
  • DUAL ANTIPLATELET THERAPY
  • OPEN-LABEL
  • TICAGRELOR MONOTHERAPY
  • ANTITHROMBOTIC THERAPY
  • CARDIOVASCULAR EVENTS
  • MYOCARDIAL-INFARCTION
  • STENT IMPLANTATION
  • EUROPEAN-SOCIETY
  • BLEEDING EVENTS
  • POSITION PAPER

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