Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, D Hannover, Germany.
Eur Heart J Cardiovasc Pharmacother. 2020 Jan 1;6(1):57-68. doi: 10.1093/ehjcvp/pvz032.
Acetyl-salicylic acid is the basic anti-thrombotic therapy used for single anti-platelet therapy in primary as well as secondary prevention of atherosclerotic disease. Dual anti-platelet therapy (DAPT) is the cornerstone of maintenance medication following elective percutaneous coronary intervention or acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). DAPT duration has been frequently discussed. Currently, guideline recommendations strengthen the importance of individualized treatment to reduce bleeding risk based on clinical predictors, of which older age is an important one. Patients aged ≥75 years are often underrepresented in randomized clinical trials, but present a patient cohort deemed both at heightened ischaemic as well as bleeding risk. We aimed to summarize the evidence or the lack of evidence for anti-platelet treatment strategies in patients aged ≥75 years including combinations with anticoagulants in secondary prevention or coronary interventions in elderly patients with atrial fibrillation. This review article represents the author's interpretation of available data and is not discussed by a formal task force; it is intended to point out missing evidence and to provide age-specific data for individualized decision making, which is currently encouraged by the guidelines.
乙酰水杨酸是用于动脉粥样硬化疾病一级和二级预防的单一抗血小板治疗的基本抗血栓治疗药物。双重抗血小板治疗（DAPT）是择期经皮冠状动脉介入治疗或急性冠状动脉综合征（ST 段抬高型心肌梗死、非 ST 段抬高型心肌梗死、不稳定型心绞痛）后维持药物治疗的基石。DAPT 持续时间经常被讨论。目前，指南建议根据临床预测因素（其中年龄较大是一个重要因素），加强基于个体化治疗以降低出血风险的重要性。年龄≥75 岁的患者在随机临床试验中代表性不足，但他们被认为存在缺血和出血风险均增加的患者群体。我们旨在总结在≥75 岁患者中（包括在二级预防中联合抗凝剂或在老年房颤患者中进行冠状动脉介入治疗）的抗血小板治疗策略的证据或缺乏证据。这篇综述文章代表了作者对现有数据的解释，没有经过正式工作组的讨论；其旨在指出缺乏证据，并为个体化决策提供特定年龄的数据，目前指南鼓励这样做。
