title: [Position paper of the Italian Society of Interventional Cardiology (SICI-GISE): antithrombotic therapy in elderly patients with acute coronary syndrome].
abstract: With the ageing of the population in the Western world, an increasing proportion of patients seen in cardiology practice is represented by the elderly. Although approximately one third of patients admitted with acute coronary syndrome (ACS) are >75 years old and the mortality rate in this age group is doubled compared with younger patients, this population is underrepresented in randomized controlled trials and, consequently, clinical guidelines do not always provide clear indications for the management of elderly patients. Therefore, there is an unmet need for clinical guidance regarding this rapidly growing subset of ACS patients, also considering that decisions about optimal antithrombotic treatment strategies in the elderly are often challenging, mostly due to age-related organ dysfunction, the frequency of comorbidities and concomitant medications and an increased risk of both ischemic and bleeding events. A panel of Italian cardiology experts assembled under the auspices of the Italian Society of Interventional Cardiology (SICI-GISE) for comprehensive discussion and consensus development, with the aim to provide practical recommendations, for both clinical and interventional cardiologists, regarding optimal management of antithrombotic therapy in patients with ACS aged ≥75 years. In this position paper, various clinical scenarios in patients with ST-elevation and non-ST-elevation myocardial infarction or unstable angina are presented and discussed, including special subsets (e.g., patients aged ≥85 years, patients with chronic renal disease or previous cerebrovascular events, patients requiring triple therapy or long-term antithrombotic therapy), with the panel's recommendations being provided for each scenario.
authors.affiliation: Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi, Padova.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: U.O. Cardiologia Diagnostica ed Interventistica, Fondazione Toscana "G. Monasterio", Ospedale del Cuore, Massa.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Dipartimento di Scienze Cardiovascolari, European Hospital, Roma.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: S.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Dipartimento Cardiovascolare, Ospedale Ca' Foncello, Treviso.
authors.forename: Luca
authors.initials: L
authors.lastname: Favero
authors.affiliation: S.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferlini
authors.affiliation: Dipartimento Cardiovascolare, Università degli Studi, Catania.
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.affiliation: U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marchese
authors.affiliation: Dipartimento di Cardiologia, Ospedale Cardarelli, Napoli.
authors.forename: Ciro
authors.initials: C
authors.lastname: Mauro
authors.affiliation: U.O. Cardiologia, Azienda Ospedaliero-Universitaria, Parma.
authors.forename: Alberto
authors.initials: A
authors.lastname: Menozzi
authors.affiliation: Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi, Padova.
authors.forename: Marco
authors.initials: M
authors.lastname: Mojoli
authors.affiliation: U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari.
authors.forename: Valeria
authors.initials: V
authors.lastname: Paradies
authors.affiliation: Divisione di Cardiologia, Ospedali degli Infermi, Rivoli (TO).
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
authors.affiliation: Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016330:Frail Elderly; D006801:Humans; D007558:Italy; D009203:Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents