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Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review

Percutaneous coronary intervention has become a mainstay in the management of coronary artery disease. While initially advanced age was considered a relative contraindication to invasive management of coronary artery disease, current cardiovascular practice stands solidly on an early invasive approa...

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Autores principales: Biondi-Zoccai, Giuseppe, Antonazzo, Barbara, Giordano, Arturo, Versaci, Francesco, Frati, Giacomo, Ronzoni, Stefano, Nudi, Alessandro, Nudi, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212118/
https://www.ncbi.nlm.nih.gov/pubmed/32395309
http://dx.doi.org/10.21037/jtd.2019.12.87
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author Biondi-Zoccai, Giuseppe
Antonazzo, Barbara
Giordano, Arturo
Versaci, Francesco
Frati, Giacomo
Ronzoni, Stefano
Nudi, Alessandro
Nudi, Francesco
author_facet Biondi-Zoccai, Giuseppe
Antonazzo, Barbara
Giordano, Arturo
Versaci, Francesco
Frati, Giacomo
Ronzoni, Stefano
Nudi, Alessandro
Nudi, Francesco
author_sort Biondi-Zoccai, Giuseppe
collection PubMed
description Percutaneous coronary intervention has become a mainstay in the management of coronary artery disease. While initially advanced age was considered a relative contraindication to invasive management of coronary artery disease, current cardiovascular practice stands solidly on an early invasive approach for elderly patients, typically based on radial access and drug-eluting stent implantation. Since the advent of coronary stents, oral antiplatelet therapy has proved crucial to maximize the benefits and minimize the risks of stenting, and this holds even truer in older patients rather than in younger ones. Indeed, the elderly is typically at higher risk of thrombotic events as well as bleeding complications, and thus careful decision making must be exercised to prescribe the most appropriate antiplatelet regimen. We thus conducted an umbrella review with scoping purposes on oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention, retrieving 8 pertinent systematic reviews. We found that, while several drugs are available, ranging from aspirin to cilostazol, clopidogrel, dipyridamole, prasugrel, ticagrelor, and ticlopidine, most commonly a dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor is recommended, with subtle adjustments for pretreatment, loading, dose, duration, escalation or de-escalation, with the potential adjunct in selected patients of novel oral anticoagulants. Indeed, a flexible and individualized approach to oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention is paramount, factoring patient features (exploiting thrombotic, bleeding and frailty scores), triage (including when appropriate non-invasive assessment of anatomic and functional significance of coronary artery disease), angiographic and other invasive imaging features, interventional technique, stent choice, rehabilitation, and secondary prevention.
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spelling pubmed-72121182020-05-11 Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review Biondi-Zoccai, Giuseppe Antonazzo, Barbara Giordano, Arturo Versaci, Francesco Frati, Giacomo Ronzoni, Stefano Nudi, Alessandro Nudi, Francesco J Thorac Dis Review Article on Interventional Cardiology Percutaneous coronary intervention has become a mainstay in the management of coronary artery disease. While initially advanced age was considered a relative contraindication to invasive management of coronary artery disease, current cardiovascular practice stands solidly on an early invasive approach for elderly patients, typically based on radial access and drug-eluting stent implantation. Since the advent of coronary stents, oral antiplatelet therapy has proved crucial to maximize the benefits and minimize the risks of stenting, and this holds even truer in older patients rather than in younger ones. Indeed, the elderly is typically at higher risk of thrombotic events as well as bleeding complications, and thus careful decision making must be exercised to prescribe the most appropriate antiplatelet regimen. We thus conducted an umbrella review with scoping purposes on oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention, retrieving 8 pertinent systematic reviews. We found that, while several drugs are available, ranging from aspirin to cilostazol, clopidogrel, dipyridamole, prasugrel, ticagrelor, and ticlopidine, most commonly a dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor is recommended, with subtle adjustments for pretreatment, loading, dose, duration, escalation or de-escalation, with the potential adjunct in selected patients of novel oral anticoagulants. Indeed, a flexible and individualized approach to oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention is paramount, factoring patient features (exploiting thrombotic, bleeding and frailty scores), triage (including when appropriate non-invasive assessment of anatomic and functional significance of coronary artery disease), angiographic and other invasive imaging features, interventional technique, stent choice, rehabilitation, and secondary prevention. AME Publishing Company 2020-04 /pmc/articles/PMC7212118/ /pubmed/32395309 http://dx.doi.org/10.21037/jtd.2019.12.87 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Interventional Cardiology
Biondi-Zoccai, Giuseppe
Antonazzo, Barbara
Giordano, Arturo
Versaci, Francesco
Frati, Giacomo
Ronzoni, Stefano
Nudi, Alessandro
Nudi, Francesco
Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
title Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
title_full Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
title_fullStr Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
title_full_unstemmed Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
title_short Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
title_sort oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review
topic Review Article on Interventional Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212118/
https://www.ncbi.nlm.nih.gov/pubmed/32395309
http://dx.doi.org/10.21037/jtd.2019.12.87
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