Antiplatelet Therapy in Older Adults with Non–ST-Segment Elevation Acute Coronary Syndrome: Considering Risks and Benefits

Antiplatelet agents play an important role in the treatment of non–ST-segment elevation acute coronary syndromes (NSTE ACS), particularly for those at high risk, such as older adults (aged ≥75 years) where treatment may yield the greatest benefits. Paradoxically, older adults are also at higher risk from bleeding complications. Most randomized trials have enrolled few older persons, so data are sparse with which to guide clinical practice. In this review, we highlight the relevant trial evidence for antiplatelet therapy (aspirin, P2Y12 inhibitors, and small molecule glycoprotein IIb/IIIa inhibitors) in NSTE ACS in relation to age, taking into consideration the risks and benefits, dose, concomitant therapy, and duration of use. Given greater potential benefits from primary and secondary prevention strategies in cardiovascular care, it is important to apply guideline recommendations in older adults. However, given their complexity, it is important to further consider the application of existing and new therapies and strategies of care in “real-world” settings.