Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic reviewCitation formats

  • External authors:
  • Maren Meinshausen
  • Anja Rieckert
  • Anna Renom-Guiteras
  • Moritz Kröger
  • Christina Sommerauer
  • Ilkka Kunnamo
  • Yolanda V. Martinez
  • Andreas Sönnichsen

Standard

Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic review. / Meinshausen, Maren; Rieckert, Anja; Renom-Guiteras, Anna; Kröger, Moritz; Sommerauer, Christina; Kunnamo, Ilkka; Martinez, Yolanda V.; Esmail, Aneez; Sönnichsen, Andreas.

In: BMC Geriatrics, Vol. 17, 225, 16.10.2017.

Research output: Contribution to journalArticle

Harvard

Meinshausen, M, Rieckert, A, Renom-Guiteras, A, Kröger, M, Sommerauer, C, Kunnamo, I, Martinez, YV, Esmail, A & Sönnichsen, A 2017, 'Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic review', BMC Geriatrics, vol. 17, 225. https://doi.org/10.1186/s12877-017-0572-7

APA

Meinshausen, M., Rieckert, A., Renom-Guiteras, A., Kröger, M., Sommerauer, C., Kunnamo, I., ... Sönnichsen, A. (2017). Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic review. BMC Geriatrics, 17, [225]. https://doi.org/10.1186/s12877-017-0572-7

Vancouver

Author

Meinshausen, Maren ; Rieckert, Anja ; Renom-Guiteras, Anna ; Kröger, Moritz ; Sommerauer, Christina ; Kunnamo, Ilkka ; Martinez, Yolanda V. ; Esmail, Aneez ; Sönnichsen, Andreas. / Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic review. In: BMC Geriatrics. 2017 ; Vol. 17.

Bibtex

@article{f68b88462e284450b41d7612d5017b10,
title = "Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic review",
abstract = "Background: Platelet aggregation inhibitors (PAI) are among the most frequently prescribed drugs in older people, though evidence about risks and benefits of their use in older adults is scarce. The objectives of this systematic review are firstly to identify the risks and benefits of their use in the prevention and treatment of vascular events in older adults, and secondly to develop recommendations on discontinuing PAI in this population if risks outweigh benefits. Methods: Staged systematic review consisting of three searches. Searches 1 and 2 identified systematic reviews and meta-analyses. Search 3 included controlled intervention and observational studies from review-articles not included in searches 1 and 2. All articles were assessed by two independent reviewers regarding the type of study, age of participants, type of intervention, and clinically relevant outcomes. After data extraction and quality appraisal we developed recommendations to stop the prescribing of specific drugs in older adults following the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Results: Overall, 2385 records were screened leading to an inclusion of 35 articles reporting on 22 systematic reviews and meta-analyses, 11 randomised controlled trials, and two observational studies. Mean ages ranged from 57.0 to 84.6 years. Ten studies included a subgroup analysis by age. Overall, based on the evaluated evidence, three recommendations were formulated. First, the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular disease (CVD) in older people cannot be recommended due to an uncertainty in the risk-benefit ratio (weak recommendation; low quality of evidence). Secondly, the combination of ASA and clopidogrel in patients without specific indications should be avoided (strong recommendation; moderate quality of evidence). Lastly, to improve the effectiveness and reduce the risks of stroke prevention therapy in older people with atrial fibrillation (AF) and a CHA2DS2-VASc score of ≥ 2, the use of ASA for the primary prevention of stroke should be discontinued in preference for the use of oral anticoagulants (weak recommendation; low quality of evidence). Conclusions: The use of ASA for the primary prevention of CVD and the combination therapy of ASA and clopidogrel for the secondary prevention of vascular events in older people may not be justified. The use of oral anticoagulants instead of ASA in older people with atrial fibrillation may be recommended. Further high quality studies with older adults are needed.",
keywords = "Acetylsalicylic acid, Aged, Antiplatelet drugs, Antiplatelet therapy, Cardiovascular disease, Cerebrovascular disease, Clopidogrel, Deprescribing, Peripheral artery occlusive disease, Platelet aggregation inhibitors, Polypharmacy, Primary prevention, Secondary prevention",
author = "Maren Meinshausen and Anja Rieckert and Anna Renom-Guiteras and Moritz Kr{\"o}ger and Christina Sommerauer and Ilkka Kunnamo and Martinez, {Yolanda V.} and Aneez Esmail and Andreas S{\"o}nnichsen",
year = "2017",
month = "10",
day = "16",
doi = "10.1186/s12877-017-0572-7",
language = "English",
volume = "17",
journal = "B M C Geriatrics",
issn = "1471-2318",
publisher = "Springer Nature",

}

RIS

TY - JOUR

T1 - Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - A systematic review

AU - Meinshausen, Maren

AU - Rieckert, Anja

AU - Renom-Guiteras, Anna

AU - Kröger, Moritz

AU - Sommerauer, Christina

AU - Kunnamo, Ilkka

AU - Martinez, Yolanda V.

AU - Esmail, Aneez

AU - Sönnichsen, Andreas

PY - 2017/10/16

Y1 - 2017/10/16

N2 - Background: Platelet aggregation inhibitors (PAI) are among the most frequently prescribed drugs in older people, though evidence about risks and benefits of their use in older adults is scarce. The objectives of this systematic review are firstly to identify the risks and benefits of their use in the prevention and treatment of vascular events in older adults, and secondly to develop recommendations on discontinuing PAI in this population if risks outweigh benefits. Methods: Staged systematic review consisting of three searches. Searches 1 and 2 identified systematic reviews and meta-analyses. Search 3 included controlled intervention and observational studies from review-articles not included in searches 1 and 2. All articles were assessed by two independent reviewers regarding the type of study, age of participants, type of intervention, and clinically relevant outcomes. After data extraction and quality appraisal we developed recommendations to stop the prescribing of specific drugs in older adults following the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Results: Overall, 2385 records were screened leading to an inclusion of 35 articles reporting on 22 systematic reviews and meta-analyses, 11 randomised controlled trials, and two observational studies. Mean ages ranged from 57.0 to 84.6 years. Ten studies included a subgroup analysis by age. Overall, based on the evaluated evidence, three recommendations were formulated. First, the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular disease (CVD) in older people cannot be recommended due to an uncertainty in the risk-benefit ratio (weak recommendation; low quality of evidence). Secondly, the combination of ASA and clopidogrel in patients without specific indications should be avoided (strong recommendation; moderate quality of evidence). Lastly, to improve the effectiveness and reduce the risks of stroke prevention therapy in older people with atrial fibrillation (AF) and a CHA2DS2-VASc score of ≥ 2, the use of ASA for the primary prevention of stroke should be discontinued in preference for the use of oral anticoagulants (weak recommendation; low quality of evidence). Conclusions: The use of ASA for the primary prevention of CVD and the combination therapy of ASA and clopidogrel for the secondary prevention of vascular events in older people may not be justified. The use of oral anticoagulants instead of ASA in older people with atrial fibrillation may be recommended. Further high quality studies with older adults are needed.

AB - Background: Platelet aggregation inhibitors (PAI) are among the most frequently prescribed drugs in older people, though evidence about risks and benefits of their use in older adults is scarce. The objectives of this systematic review are firstly to identify the risks and benefits of their use in the prevention and treatment of vascular events in older adults, and secondly to develop recommendations on discontinuing PAI in this population if risks outweigh benefits. Methods: Staged systematic review consisting of three searches. Searches 1 and 2 identified systematic reviews and meta-analyses. Search 3 included controlled intervention and observational studies from review-articles not included in searches 1 and 2. All articles were assessed by two independent reviewers regarding the type of study, age of participants, type of intervention, and clinically relevant outcomes. After data extraction and quality appraisal we developed recommendations to stop the prescribing of specific drugs in older adults following the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Results: Overall, 2385 records were screened leading to an inclusion of 35 articles reporting on 22 systematic reviews and meta-analyses, 11 randomised controlled trials, and two observational studies. Mean ages ranged from 57.0 to 84.6 years. Ten studies included a subgroup analysis by age. Overall, based on the evaluated evidence, three recommendations were formulated. First, the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular disease (CVD) in older people cannot be recommended due to an uncertainty in the risk-benefit ratio (weak recommendation; low quality of evidence). Secondly, the combination of ASA and clopidogrel in patients without specific indications should be avoided (strong recommendation; moderate quality of evidence). Lastly, to improve the effectiveness and reduce the risks of stroke prevention therapy in older people with atrial fibrillation (AF) and a CHA2DS2-VASc score of ≥ 2, the use of ASA for the primary prevention of stroke should be discontinued in preference for the use of oral anticoagulants (weak recommendation; low quality of evidence). Conclusions: The use of ASA for the primary prevention of CVD and the combination therapy of ASA and clopidogrel for the secondary prevention of vascular events in older people may not be justified. The use of oral anticoagulants instead of ASA in older people with atrial fibrillation may be recommended. Further high quality studies with older adults are needed.

KW - Acetylsalicylic acid

KW - Aged

KW - Antiplatelet drugs

KW - Antiplatelet therapy

KW - Cardiovascular disease

KW - Cerebrovascular disease

KW - Clopidogrel

KW - Deprescribing

KW - Peripheral artery occlusive disease

KW - Platelet aggregation inhibitors

KW - Polypharmacy

KW - Primary prevention

KW - Secondary prevention

UR - http://www.scopus.com/inward/record.url?scp=85031668488&partnerID=8YFLogxK

U2 - 10.1186/s12877-017-0572-7

DO - 10.1186/s12877-017-0572-7

M3 - Article

VL - 17

JO - B M C Geriatrics

JF - B M C Geriatrics

SN - 1471-2318

M1 - 225

ER -