Antithrombotic therapy represents the mainstay of treatment in patients
with coronary artery disease (CAD), including elderly patients who are
at increased risk for ischemic recurrences. However, the elderly
population is also more vulnerable to bleeding complications. Numerous
mechanisms, including abnormalities in the vasculature, thrombogenicity,
comorbidities, and altered drug response, contribute to both increased
thrombotic and bleeding risk. Age-related organ changes and drug-drug
interactions secondary to polypharmacy lead to distinct pharmacokinetic
and pharmacodynamic profiles of antithrombotic drugs. Overall these
factors contribute to the risk-benefit profiles of antithrombotic
therapies in elderly subjects and underscore the need for treatment
regimens that can reduce bleeding while preserving efficacy. Given that
the prevalence of CAD, as well as concomitant diseases with
thromboembolic potential, such as atrial fibrillation, increases with
age and that the elderly population is in continuous growth,
understanding the safety and efficacy of different antithrombotic
regimens is pivotal for patient-centered care. In the present overview
the authors appraise the available data on the use of antithrombotic
therapy in older patients with CAD to assist with the management of this
high-risk population and define knowledge gaps that can set the basis
for future research.
