【医脉通-指南】2015+ESC专家共识：老年人抗血栓治疗_图文_百度文库
【医脉通-指南】2015+ESC专家共识：老年人抗血栓治疗
European Heart Journal Advance Access published July 9, 2015
EuropeanHeartJournalCURRENTOPINIONdoi:10.1093/eurheartj/ehv304
Antithrombotictherapyintheelderly:expertpositionpaperoftheEuropeanSocietyof
CardiologyWorkingGrouponThrombosis
FelicitaAndreotti1*,BiancaRocca2,SteenHusted3,RamziA.Ajjan4,JurrientenBerg5,MarcoCattaneo6,Jean-PhilippeCollet7,RaffaeleDeCaterina8,KeithA.A.Fox9,SigrunHalvorsen10,KurtHuber11,ElaineM.Hylek12,GregoryY.H.Lip13,
GillesMontalescot14,JoaoMorais15,CarloPatrono2,FreekW.A.Verheugt16,LarsWallentin17,ThomasW.Weiss11,andRobertF.Storey18,onbehalfoftheESCThrombosisWorkingGroup
1DepartmentofCardiovascularScience,CatholicUniversityMedicalSchool,LargoFVito1,Rome00168,I2InstituteofPharmacology,CatholicUniversitySchoolofMedicine,Rome,I3MedicalDepartment,RegionHospitalWest,Herning/Holstebro,D4DivisionofCardiovascularandDiabetesResearch,TheLIGHTLaboratories,MultidisciplinaryCardiovascularResearchCentre,UniversityofLeeds,Leeds,UK;5DepartmentofCardiology,St.AntoniusHospital,Nieuwegein,theN6Medicina3,OspedaleSanPaolo–DipartimentodiSCienzedellaSalute,UNiversita`degliStudidiMilano,Milan,I7InstitutdeCardiologie,INSERMUMRS1166,AlliesinCardiovascularTrialsInitiativesandOrganizedNetworksGroup,Pitie?-Salpe^trie`reHospital(AssistancePublique–Ho^pitauxdeParis),Universite?PierreetMarieCurie,Paris,F8DepartmentofCardiology,‘G.d’Annunzio’University–OspedaleSS.Annunziata,Chieti,I9CentreforCardiovascularScience,UniversityofEdinburgh,Edinburgh,UK;10DepartmentofCardiologyB,OsloUniversityHospital,andInstituteofClinicalMedicine,UniversityofOslo,Oslo,N113rdDepartmentofInternalMedicine,CardiologyandEmergencyMedicine,WilhelminenHospital,Montleartstrasse37,ViennaA-1160,A12DepartmentofMedicine,BostonUniversitySchoolofMedicine-BostonMedicalCenter,Boston,MA,USA;13UniversityofBirminghamCentreforCardiovascularSciences,CityHospital,BirminghamB187QH,UK;14InstitutdeCardiologie,INSERMUMRS1166,Pitie?-Salpe^trie`reHospital(AssistancePublique–Ho^pitauxdeParis),Universite?PierreetMarieCurie,Paris,F15DepartmentofCardiology,HospitaldeSantoAndre?,Leiria,P16OnzeLieveVrouweGasthuis(OLVG),Amsterdam,theN17UppsalaClinicalResearchCenterandDepartmentofMedicalSciences(Cardiology),UppsalaUniversity,Uppsala,Sand18DepartmentofCardiovascularScience,UniversityofSheffield,Sheffield,UK
Received9August2014;revised24May2015;accepted12June2015
Introductionriskofbothbleedingandischaemicevents,3,5,12frequentcomorbid-
ities/comedication,andreducedadherencetoprescriptions.Given
Contemporarymedicineisshiftingtowardspersonratherthanthechallengesofantithrombotictreatmentintheelderly,thedisease-orientedcare.1Withincreasinglifeexpectancyandtheage-EuropeanSocietyofCardiology(ESC)WorkingGrouponThrom-ingofbabyboomers,theproportionover60yearsisgrowingfasterbosisgatheredataskgrouptoaddressthetopic.
thantheoverallpopulation,withworldwideestimatesreaching
2billionby2050(http://www.un.org/esa/population/publications/
worldageingInparallel,acutecoronarysyndromesIntegratingageintoischaemicand(ACS)andatrialfibrillation(AF)—themostfrequentindications
fordualplateletinhibitionoranticoagulation—occurmostlyinold-bleedingrisks
erpatients.2–6Thereisgeneralagreementthatpeople≥75yearsAntiplatelet,anticoagulant,andfibrinolyticdrugscanprevent,post-canbedefined‘elderly’;however,cutoffsaslowas65yearshavepone,orattenuatetheseverityofthromboticevents—namelybeenappliedtoimportantclinicaldatasetsandriskscores.3,7–10stroke,transientischaemicattack(TIA),MI,systemicembolismMoreover,ageingisacontinuousprocessandlife-spanexpansion(SE),deepveinthrombosis(DVT),orpulmonaryembolismisdeflating(http://www.nber.org/papers/w18407).Fortheserea-(PE)—andretardcardiovascularandall-causedeath,butatthesons,athresholdtodefine‘elderly’hasbeenintentionallyavoidedcostofincreasedbleeding.Thecriticalconundrumiswhether,ininthisdocument.Ofnote,overonethirdofpatientsadmittedtheolderpatient,thebenefitsoutweighthebleedingrisks,givenwithacutemyocardialinfarction(MI)andtwothirdsdyingfromthatbleedingassociateswithearliermortality13,14andthatpredic-MIareover75years,but,7%ofpatientsinACStrialsarereportedtorsofischaemicvs.bleedingeventsoftenco-exist,asillustrated≥75years.11Olderpatientshavemulti-organchanges,increasedbytheprogressivelyincreasinghazardsofbothoutcomes
withTheopinionsexpressedinthisarticlearenotnecessarilythoseoftheEditorsoftheEuropeanHeartJournaloroftheEuropeanSocietyofCardiology.
*Correspondingauthor.Tel:+,Fax:+,Email:felicita.andreotti@iol.it
PublishedonbehalfoftheEuropeanSocietyofCardiology.Allrightsreserved.&TheAuthor2015.Forpermissionspleaseemail:journals..
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