Health & Medical Heart Diseases

Bridging the Gap Between Clinical Trials of Antiplatelet Therapies and Applications Among Elderly Pa

Bridging the Gap Between Clinical Trials of Antiplatelet Therapies and Applications Among Elderly Patients

Abstract and Introduction

Abstract


Although patients aged ≥75 years represent nearly 40% of all those hospitalized with acute coronary syndromes, their enrollment in trials of therapeutic interventions has been relatively modest. Thus, scarce information exists to guide clinicians in decision-making and assessing projections of safety and efficacy for antiplatelet agents. The pathobiology of aging, including age-related changes in vascular repair and integrity, applies to patient management and offers a platform for investigation. Because older patients receive excess dosing of antithrombotic agents much more often than their younger counterparts do, initial steps toward optimized care include attention to indications, dosing, and duration of treatment. This review, representing a summary of information presented at the Fourth Annual Platelet Colloquium held in Washington, DC, in January 2009 and supplemented with recent clinical trial results, underscores an increasingly narrow safety index for antiplatelet agents in the elderly and the all-important balance of safety and efficacy—a dynamic continuum that remains paramount in quality of care. Considerations for future trial designs, registries, and analyses of existing data are highlighted to better guide clinicians toward the optimal management of this rapidly growing, high-risk group.

Introduction


The elderly (age ≥75 years) represent about 40% of all inpatients with acute coronary syndromes (ACS). Their representation in randomized trials of ACS pharmacotherapies, however, including platelet-directed medications, has historically been low owing to concerns about comorbid conditions and increased bleeding risk. This review, based on information presented at the industry-funded Fourth Annual Platelet Colloquium (see online Appendix for industry sponsorships) held in Washington, DC, in January 2009, centers on parameters and predictors of safety and efficacy associated with the use of antiplatelet agents among elderly patients. It discusses fundamental concepts of platelet biology and hemostasis, pharmacology, and clinical trials as a platform for understanding and overcoming existing barriers to achieving optimal care. Finally, the recent PLATO and CHAMPION trials are discussed to examine whether the knowledge gap is narrowing with respect to antiplatelet therapies and elderly patients.

SHARE
RELATED POSTS on "Health & Medical"
Sparking Innovation: Patients First, Mice Second
Sparking Innovation: Patients First, Mice Second
Beating Heart Disease the Natural Way!
Beating Heart Disease the Natural Way!
Review of Robotic-Assisted, Totally Endoscopic CABG
Review of Robotic-Assisted, Totally Endoscopic CABG
Lower LDL Cholesterol Naturally
Lower LDL Cholesterol Naturally
What is a Good Ratio For LDL to HDL? A Simple Guide
What is a Good Ratio For LDL to HDL? A Simple Guide
Homocysteine Danger Seems to Be Ignored by Doctors
Homocysteine Danger Seems to Be Ignored by Doctors
City Dwellers Have More Heart Disease
City Dwellers Have More Heart Disease
Warning Signs of Heart Disease in Women
Warning Signs of Heart Disease in Women
fish oil infused vegetables
fish oil infused vegetables
Tips For a Healthy Heart
Tips For a Healthy Heart
Understanding Diagnosis and Treatment of Aneurysms
Understanding Diagnosis and Treatment of Aneurysms
Cutting Balloon Angioplasty for Underexpanded Stent
Cutting Balloon Angioplasty for Underexpanded Stent
Five Ways To Lower Cholesterol - And A Case History
Five Ways To Lower Cholesterol - And A Case History
VTE in Primary Care: Patient Management With Rivaroxaban
VTE in Primary Care: Patient Management With Rivaroxaban
What Are the Key Symptoms of Heart Disease?
What Are the Key Symptoms of Heart Disease?
A Few Whiffs of Smoke May Harm Your Heart
A Few Whiffs of Smoke May Harm Your Heart
Giant Cell Myocarditis
Giant Cell Myocarditis
Vitamin C Heart Disease Cure
Vitamin C Heart Disease Cure
Kexin Type 9 Inhibitor Alirocumab in High Risk Patients
Kexin Type 9 Inhibitor Alirocumab in High Risk Patients
Discover How to Lower Cholesterol - Important Techniques For You to Use
Discover How to Lower Cholesterol - Important Techniques For You to Use
Managing Hypertension, Part I: Diuretics
Managing Hypertension, Part I: Diuretics
SAPIEN Transcatheter Heart Valve for High-Risk Aortic Stenosis
SAPIEN Transcatheter Heart Valve for High-Risk Aortic Stenosis

Leave Your Reply

*