Antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes

Roberta De Rosa, Federico Piscione, Gennaro Galasso, Stefano De Servi, Stefano Savonitto

Research output: Contribution to journalArticlepeer-review


With population ageing and rise of life expectancy, a progressively increasing proportion of patients presenting with an acute coronary syndrome (ACS) are older adults, including those at extreme chronological age. Increasing amounts of data, including randomized clinical trials, have shown that the benefits of an early revascularization are maintained also at very old age, resulting in improved outcome after an acute coronary event. On the contrary, the optimal antiplatelet therapy (APT) remains unclear in these patients, because of both safety and efficacy concerns. Indeed, age-related multiple organ dysfunction and high prevalence of comorbidities may on the one hand reduce the therapeutic effects of administered drugs; on the other hand, it leads to increased vulnerability to drug toxicity and side effects. Therefore, management of APT is particularly challenging in elderly patients because of higher risk of both ischemic and bleeding events. The aim of the present paper is to review the current evidence, gaps in knowledge and ongoing research regarding APT in the setting of an ACS in elderly and very elderly patients, and in those with significant comorbidities including chronic kidney disease, diabetes mellitus and frailty.

Original languageEnglish
Pages (from-to)103-113
Number of pages11
JournalJournal of Geriatric Cardiology
Issue number2
Publication statusPublished - Feb 28 2019


  • Acute coronary syndrome
  • Antiplatelet therapy
  • The elderly

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine


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