Half a dose is enough

Older people need smaller doses of antiplatelet agents

ABC MagazineA study by scientists from the Duke Clinical Research Institute has proved that for patients over 75 years old with a diagnosis of acute coronary syndrome, half a dose of a modern antiplatelet is as effective as a whole dose of a traditional drug.

The scientists' article can be found in the journal Circulation (Roe et al., Elderly Patients with Acute Coronary Syndromes Managed Without Revascularization Insights into the Safety of Long-Term Dual Antiplatelet Therapy with Reduced-Dose Prasugrel vs. Standard-Dose Clopidogrel).

The problem of dosage of medicines for the elderly is very acute. As life expectancy increases in most countries, an increasing number of people live to an age when there is an extremely high probability of developing a myocardial infarction (35 percent of patients with acute coronary syndrome are aged 75 years or older). At the same time, elderly patients are very sensitive to the side effects of drugs used to treat this condition. Large doses of antiplatelet drugs, in particular, can cause them to bleed heavily. Therefore, it became necessary to develop new standards for the treatment of infarction in such patients, which would be based on the results of relevant clinical studies.

Previous studies have shown that taking the antiplatelet agent prazugrel reduces the risk of complications in patients with acute coronary syndrome, compared with the usual dose of the traditional antiplatelet agent clopidogrel. In that study, the initial dose of the drug was 60 mg, and then the maintenance dose was 10 mg/day. However, the observation showed that against the background of such a dosage of the drug in patients older than 75 years and in young patients weighing less than 66 kg, the risk of fatal intracranial bleeding increases. Therefore, the FDA has published recommendations according to which the maintenance dose for such patients should be 5 mg / day.

To verify the efficacy and safety of a half dose of prasugrel in the elderly, researchers from the Duke Institute analyzed data on more than 2,000 elderly patients who participated in a large clinical trial of TRILOGY ACS, which compared the effectiveness of prasugrel and clopidogrel in the treatment of acute coronary symptoms. The results showed that patients aged 75 years and older do not have an increased risk of bleeding while taking 5 or 10 mg of prasugrel per day, compared with clopidogrel at a dosage of 75 mg, which is currently most often used to relieve acute coronary syndrome in the elderly. Consequently, the desired effect of antiplatelet therapy can be achieved without resorting to higher doses and without increasing the risk of dangerous bleeding.

Portal "Eternal youth" http://vechnayamolodost.ru20.08.2013