Antiplatelet duration in the elderly patients after percutaneous coronary intervention

• Published in: Annales de cardiologie et d'angeiologie Vol. 67; no. 6; p. 411
• Main Authors: Sokoloff, A, Picard, F, Degrell, P, Varenne, O
• Format: Journal Article
• Language: French
• Published: France 01.12.2018
• Subjects: Aged; Coronary Artery Disease - therapy; Drug Administration Schedule; Drug Therapy, Combination; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - administration & dosage; Practice Guidelines as Topic; Proton Pump Inhibitors - therapeutic use; Risk Assessment; Antiplatelet therapy; Coronaropathie; Antiagrégation plaquettaire; Coronary artery disease
• ISSN: 1768-3181
• DOI: 10.1016/j.ancard.2018.09.015

Ischemic heart disease is a leading cause of death in Europe. At the same time, older patients are at high risk for coronary heart disease and represent an increasing proportion of patients in the catheterization laboratory in the context of an ageing population. The elderly patients are also at higher bleeding risk, and were poorly represented in major randomized trials. Duration of dual antiplatelet therapy (DAPT), after percutaneous coronary intervention (PCI) should be modulated in a personalized way taking into account hemorrhagic and ischemic risk factors, using risk scores based on the latest recommendations of the European Society of Cardiology. Even if the optimal duration of DAPT after PCI is 6 months in case of stable coronary disease and 12 months in case of an acute coronary syndrome, it can be drastically reduced, up to one month in case of high hemorrhagic risk, or can be prolonged for more than 12 months in case of high ischemic risk. The use of latest generation drug eluting stents associated with a short duration of DAPT has thus demonstrated its safety compared to these durations. In case of triple therapy treatment, associating DAPT and anticoagulation therapy, DAPT is recommended to be as short as possible, potentially reduced to 1 month. Finally, the concomitant prescription of proton pump inhibitor is essential to prevent gastrointestinal bleedings. This literature review will discuss the hemorrhagic risk stratification and choice of DAPT in elderly patients.