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Safety considerations with the use of platelet inhibitors for elderly patients with non-ST- elevation acute coronary syndrome.
- Source :
-
Expert opinion on drug safety [Expert Opin Drug Saf] 2021 Dec; Vol. 20 (12), pp. 1545-1552. Date of Electronic Publication: 2021 Jun 13. - Publication Year :
- 2021
-
Abstract
- Introduction : Dual antiplatelet therapy (DAPT) is standard treatment for patients with acute coronary syndrome (ACS). This includes lifelong aspirin combined with a P2Y <subscript>12</subscript> inhibitor for 1 year. The indication for one of the P2Y <subscript>12</subscript> 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.
- Subjects :
- Acute Coronary Syndrome physiopathology
Age Factors
Aged
Cytochrome P-450 CYP2C19 genetics
Dual Anti-Platelet Therapy adverse effects
Genotype
Hemorrhage chemically induced
Humans
Platelet Aggregation Inhibitors adverse effects
Platelet Function Tests
Thrombosis prevention & control
Acute Coronary Syndrome drug therapy
Dual Anti-Platelet Therapy methods
Platelet Aggregation Inhibitors administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1744-764X
- Volume :
- 20
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Expert opinion on drug safety
- Publication Type :
- Academic Journal
- Accession number :
- 34106029
- Full Text :
- https://doi.org/10.1080/14740338.2021.1936498