Antiplatelet therapy of atrial fibrillation: Focus on the elderly
Current guidelines for the management of atrial fibrillation (AF) recommend using anticoagulants as first-line drugs for stroke prevention, but in real medical practice antiplatelet drugs are often prescribed to elderly patients. Review of clinical and pharmacoepidemiological studies allows us to conclude that risk associated with acetylsalicylic acid (ASA) use in patients ≥75 years can overweigh its potential benefit. Other antiplatelet drugs are poorly studied in patients with AF. Dual antiplatelet therapy (ASA + clopidogrel) can be prescribed to elderly patients with cardiovascular comorbidity who are deemed unsuitable candidates for anticoagulant therapy for reasons other than bleeding risk or those who refuse to take oral anticoagulants. Combined therapy of antiplatelet drugs with warfarin or new oral anticoagulants results in no reduction in stroke rate compared with anticoagulant monotherapy but is associated with increased risk of bleeding and can't be recommended.