#023 Antiplatelet Therapy in Coronary Disease
Authors: Guru Krishnan, Kathryn Denson MD, Gabriel Manzi MD, Diane Brown
In patients with coronary artery disease:
List the choices for antiplatelet therapy and their mechanism of action.
List current recommendations regarding type and duration of antiplatelet therapy in patients with/without coronary stents.
Context: Geriatric patient with coronary artery disease (CAD).
Action: Provide antiplatelet therapy recommendations in CAD patients with/without coronary stents.
Incidence/Prevalence: Age is an important determinant of outcome in patients with coronary artery disease. Antiplatelet therapy has been shown to improve outcomes, however, antiplatelet agents are prescribed less in the advanced age group due to limited trial data guiding care and uncertainty about benefit/risk, complex health status, and medication interactions.
Choices for antiplatelet therapy and their mechanism of action:
View larger image
Discontinuation of antiplatelet therapy:
Discontinue dual antiplateleting
Continue aspirin for one year
Underlying Science: Platelet plug formation: The process starts when the platelets are in contact with a damaged vascular wall exposing collagen fibers.  The platelet body is transformed (edema, irradiating pseudopods, and its wall becomes sticky).  The platelet contracts releasing granules with activating factors (actin, myosin, thrombosthenin, prostaglandins, calcium).  The activated platelet is adhered to collagen and to Von Willebrand factor and releases large amounts of adenosine biphosphate (ADP) and thromboxane A2, which activates new platelets.
ACGME Competencies: Patient Care, Medical Knowledge
Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina), J Am Coll Cardiol 2002. 40(7) 1366-1374.
Vandvik PO, Lincoff AM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso-Coello P, MD, Akl EA, Lansberg MG, Guyatt GH, Spencer FA, American College of Chest Physicians. Primary and Secondary Prevention of Cardiovascular Disease Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012. 141(2 suppl):e637s-68s.
Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm
Copyright/Referencing Information: Users are free to download and distribute Geriatric Fast Facts for educational purposes only. Citation: Guru Krishnan, Kathryn Denson MD, Gabriel Manzi MD, Diane Brown, Fast Fact #23: Antiplatelet Therapy in Coronary Disease, February, 2013.
Geriatric Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm
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