Considerations Regarding Antiplatelet Therapy in the Elderly

Adults over the age of 65 years represent more than half of the patients living with heart disease in the United States. However, the majority of the large, multi-center, randomized clinical trials that have led to the creation of the guidelines for antiplatelet therapy have enrolled only a small number of elderly patients. This article reviews the published data on antiplatelet therapy for coronary artery and cerebrovascular disease, focusing on elderly patients. We found evidence to support the use of aspirin for both primary and secondary prevention of ischemic heart disease, and of aspirin and clopidogrel in the setting of acute coronary syndromes and for stroke prevention in patients with atrial fibrillation not on anticoagulation. Further studies are needed to characterize the benefits and risks in the elderly of prasugrel, ticagrelor and the glycoprotein IIb/IIIa inhibitors.