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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/21718

Title: Drug Treatment of STEMI in the Elderly: Focus on Fibrinolytic Therapy and Insights from the STREAM Trial
Authors: Sinnaeve, Peter R.
Danays, Thierry
Bogaerts, Kris
Van de Werf, Frans
Armstrong, Paul W.
Issue Date: 2016
Publisher: ADIS INT LTD
Citation: DRUGS & AGING, 33 (2), p. 109-118
Abstract: Elderly patients constitute a large and growing proportion of ST-elevation myocardial infarction (STEMI) patients, yet they have been under-represented or even excluded from reperfusion trials. Despite evidence that fibrinolysis improves outcomes irrespective of age, many elderly STEMI patients still remain undertreated or subject to major delays to primary percutaneous coronary intervention (PCI). The fear of an excessive risk of intracranial hemorrhage (ICH) in these patients can lead to avoidance of potentially life-saving reperfusion treatment, despite the fact that current STEMI guidelines do not exclude the elderly from a pharmaco-invasive strategy. Age-specific dose reductions have been succesfully made to antithrombotic drugs such as clopidogrel and enoxaparin as an adjunct to fibrinolysis, but until recently no dose adjustments for elderly patients have been applied to the fibrinolytic agents. In the pharmaco-invasive STREAM trial, halving the bolus of tenecteplase for patients aged >75 years because of an unacceptably high ICH rate in the elderly was associated with a more favorable safety/efficacy profile. Whether a pharmaco-invasive strategy including half-dose tenecteplase, age- and weight-adjusted enoxaparin, and a tailored P2Y(12) inhibitor followed by routine angiography represents a safe and efficacious alternative reperfusion therapy for elderly patients remains to be prospectively assessed in a clinical trial in this age group.
Notes: [Sinnaeve, Peter R.; Van de Werf, Frans] Katholieke Univ Leuven, Univ Hosp Leuven, Leuven, Belgium. [Danays, Thierry] Boehringer Ingelheim GmbH & Co KG, Reims, France. [Bogaerts, Kris] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat, Leuven, Belgium. [Bogaerts, Kris] Univ Hasselt, Hasselt, Belgium. [Armstrong, Paul W.] Univ Alberta, Canadian Virtual Coordinating Ctr Global Collobor, Edmonton, AB, Canada.
URI: http://hdl.handle.net/1942/21718
DOI: 10.1007/s40266-016-0345-6
ISI #: 000370382800004
ISSN: 1170-229X
Category: A1
Type: Journal Contribution
Validation: ecoom, 2017
Appears in Collections: Research publications

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