Aging Medicine · 2 authors, 2 centres
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This document is a Chinese expert consensus providing clinical recommendations for antithrombotic therapy in elderly patients (≥65 years) with chronic coronary syndrome, particularly those at high ischemic or bleeding risk. It synthesizes evidence to standardize treatment for complex scenarios like concomitant atrial fibrillation or venous thromboembolism, but the recommendations are based on expert opinion and existing evidence, not new clinical trials.
This consensus aims to standardize antithrombotic management for high-risk elderly patients with chronic coronary syndrome (CCS). It defines the population as patients ≥65 years with CAD and provides a framework for assessing high ischemic risk (e.g., age ≥80, multi-vessel disease) and high bleeding risk. The document presents numerous recommendations for antiplatelet and anticoagulant therapies across various clinical scenarios, including CCS alone, CCS with atrial fibrillation (AF), and CCS with venous thromboembolism (VTE). Key recommendations include using dual antiplatelet therapy (DAPT) for specific durations post-percutaneous coronary intervention (PCI), prioritizing oral anticoagulant monotherapy over combination therapy for CCS patients with AF based on risk scores (e.g., CHA₂DS₂-VASc, HAS-BLED), and tailoring antithrombotic regimens for patients with VTE based on the timing of ACS or PCI. The guidance emphasizes balancing ischemic and bleeding risks, especially given age-related comorbidities and polypharmacy. As an expert consensus, its primary limitation is the reliance on existing literature and expert opinion rather than presenting new primary research data. The implications are for clinical practice in geriatric cardiology, offering a structured approach to managing complex antithrombotic decisions in an aging population.
