Cor Vasa 2023, 65(Suppl. 1):7-22 | DOI: 10.33678/cor.2023.012

(Acute, periprocedural and longterm antithrombotic therapy in older adults: 2022 Update by the ESC Working Group on Thrombosis. Translation of the document prepared by the Czech Society of Cardiology)

Miloš Táborský^a, Zuzana Moťovská^b, Petr Ošťádal^c

^a I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc

^b Kardiologická klinika, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha

^c Kardiovaskulární centrum, Nemocnice Na Homolce, Praha

The fi rst international guidance on antithrombotic therapy in the elderly came from the European Society of Cardiology Working Group on Thrombosis in 2015. This same group has updated its previous report on antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fi brillation, or undergoing surgery or procedures typical of the elderly (transcatheter aortic valve implantation
and left atrial appendage closure). The aim is to provide a succinct but comprehensive tool for readers to understand the bases of antithrombotic therapy in older patients, despite the complexities of comorbidities, comedications and uncertain ischaemic- vs. bleeding-risk balance. Fourteen updated consensus statements integrate recent trial data and other evidence, with a focus on high bleeding risk. Guideline recommendations,
when present, are highlighted, as well as gaps in evidence. Key consensus points include efforts to improve medical adherence through deprescribing and polypill use; adoption of universal risk defi nitions for bleeding, myocardial infarction, stroke and cause-specifi c death; multiple bleeding-avoidance strategies, ranging from gastroprotection with aspirin use to selection of antithrombotic-drug composition, dosing and duration tailored to multiple variables (setting, history, overall risk, age, weight, renal function, comedications, procedures) that need special consideration when managing older adults.

Keywords: Anticoagulant, Antiplatelet, Atrial fibrillation, Coronary syndromes, Elderly, LAAC, Surgery, TAVI

Received: February 11, 2023; Revised: February 11, 2023; Accepted: February 17, 2023; Published: April 30, 2023  Show citation