De-escalating dual antiplatelet therapy in patients with acute coronary syndromes: the right strategy to harmonize time-dependent ischemic and bleeding risk in elderly patients? Journal of Cardiovascular Medicine

G. Crimi, R. De Rosa, A. Mandurino-Mirizzi, N. Morici, L.P. Alberti, S. Savonitto, S. De Servi

Research output: Contribution to journalArticlepeer-review

Abstract

The European Society of Cardiology guidelines for myocardial revascularization state that de-escalation of P2Y12 inhibitor treatment guided by platelet function testing may be considered for acute coronary syndrome (ACS) patients deemed unsuitable for 12-month potent platelet inhibition. De-escalation strategy aim is to harmonize the time-dependency of thrombotic risk, which is high in the first month after ACS, then decreases exponentially, with bleeding risk, which tends to remain more stable after the procedure-related peak. Harmonizing time-dependency of clinical events may be particularly relevant in those at high risk, such as the elderly patients with ACS in whom an individualized antiplatelet therapy may be more appropriate than a 'one-size-fits all' approach. In this review, we outline the current medical evidence on the topic of dual antiplatelet therapy de-escalation. In addition, we include insights from the Elderly ACS 2 study and recently published post-hoc analyses conducted by the authors' consortium, which further expands current knowledge. © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.
Original languageEnglish
Pages (from-to)281-285
Number of pages5
JournalJ. Cardiovasc. Med.
Volume21
Issue number4
DOIs
Publication statusPublished - 2020

Keywords

  • dual antiplatelet therapy
  • elderly patients
  • high bleeding risk
  • acetylsalicylic acid
  • antithrombocytic agent
  • clopidogrel
  • prasugrel
  • purinergic P2Y receptor antagonist
  • acute coronary syndrome
  • aged
  • bleeding
  • cardiovascular mortality
  • cerebrovascular accident
  • drug dose escalation
  • geriatric patient
  • heart infarction
  • high risk patient
  • human
  • ischemia
  • low drug dose
  • percutaneous coronary intervention
  • Review
  • risk
  • thrombocyte function
  • adverse event
  • age
  • diagnostic imaging
  • drug administration
  • risk assessment
  • risk factor
  • thrombosis
  • time factor
  • treatment outcome
  • very elderly
  • Acute Coronary Syndrome
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Drug Administration Schedule
  • Dual Anti-Platelet Therapy
  • Hemorrhage
  • Humans
  • Percutaneous Coronary Intervention
  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • Risk Assessment
  • Risk Factors
  • Thrombosis
  • Time Factors
  • Treatment Outcome

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