Acute coronary syndromes: more or less antithrombotic medi-cation for the elderly?

The treatment of elderly patients with acute coronary syndromes (ACS) remains challenging. About two thirds of patients with ACS and four fifth of patients who died from ACS are older than 65 years.1 In spite of the tremendous ad-vances in our understanding of its pathophysiolgy during the past decades and multiple treatment options we now have, ACS is still a leading cause of death., both in developed countries and in many developing countries, including China. ACS re-sult from the disruption of the atherosclerotic plaque, leading to intracoronary thrombus formation with aggregated plate-lets within a fibrin mesh. In light of this, fibrinolitics, antiplatelet and anticoagulant agents, together with revascularizations and beta blockers, are currently major com-ponents of therapy for ACS .Because of the shift of risk ben-efit ratio among different age groups, it is extremely complex to evaluate the potential risk and benefit for each of these intervention. For example, there has been considerable con-troversy around whether the results of thrombolysis trials, con-ducted mainly in younger patients, can be applied to elderly patients. Frequently the evaluation should be performed on an individualized basis at the treating physician's discretion.