{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:43:46Z","timestamp":1788965026465,"version":"build-2803163510"},"reference-count":111,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The number of elderly patients requiring antithrombotic therapy (for example, those with atrial fibrillation, ischemic heart disease, peripheral arterial disease, or venous thrombo-embolism) is increasing worldwide due to population aging. These patients are often frail and therefore at increased risk of both thromboembolic events and bleeding complications during antithrombotic treatment. Therapeutic decision-making is further complicated by the underrepresentation of older adults in large randomized trials and the resulting scarcity of age-specific, evidence-based data. As a result, their management is not guided by specific recommendations but rather relies on clinician evaluation in an individualized, patient-by-patient approach. The aim of this narrative review is to discuss the current optimal therapeutic strategies for the management of elderly patients in different clinical conditions requiring antithrombotic therapy. We analyze the efficacy and safety of the different anti-thrombotic drugs and guidelines indications by discussing the clinical data available from randomized as well as observational studies. At the same time, we focus into the future of antithrombotic therapy presenting new drugs and new strategies for the management of elderly patients requiring antithrombotic therapy.<\/jats:p>","DOI":"10.3390\/jcm14207340","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:39:34Z","timestamp":1760701174000},"page":"7340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Antithrombotic Therapy in the Elderly with Cardiovascular Disease: Walking the Tightrope Between Efficacy and Bleeding Risk\u2014A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7964-4479","authenticated-orcid":false,"given":"Alessandro","family":"Sciahbasi","sequence":"first","affiliation":[{"name":"Interventional Cardiology, Sandro Pertini Hospital\u2014ASL RM2, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Minardi","sequence":"additional","affiliation":[{"name":"Cardiology, Sant\u2019Eugenio Hospital\u2014ASL RM2, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Salvi","sequence":"additional","affiliation":[{"name":"Interventional Cardiology, Sandro Pertini Hospital\u2014ASL RM2, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-657X","authenticated-orcid":false,"given":"Fabio","family":"Infusino","sequence":"additional","affiliation":[{"name":"Interventional Cardiology, Sandro Pertini Hospital\u2014ASL RM2, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Granatelli","sequence":"additional","affiliation":[{"name":"Interventional Cardiology, Sandro Pertini Hospital\u2014ASL RM2, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.jacc.2018.03.022","article-title":"Multimorbidity in Older Adults with Cardiovascular Disease","volume":"71","author":"Forman","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101092","DOI":"10.1016\/j.arr.2020.101092","article-title":"Atrial fibrillation in the elderly: A risk factor beyond stroke","volume":"61","author":"Bencivenga","year":"2020","journal-title":"Ageing Res. Rev."},{"key":"ref_3","unstructured":"(2025, October 15). Technical Advisory Group for Measurement, Monitoring and Evaluation of the United Nation\u2019s Decade of Healthy Ageing. Available online: https:\/\/www.who.int\/groups\/technical-advisory-group-for-measurement-monitoring-and-evaluation-of-the-un-decade-of-healthy-ageing\/about-us."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"249","DOI":"10.15441\/ceem.17.261","article-title":"Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department","volume":"5","author":"Lee","year":"2018","journal-title":"Clin. Exp. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.jcin.2024.01.284","article-title":"Chronological vs Biological Age in Interventional Cardiology: A Com-prehensive Approach to Care for Older Adults: JACC Family Series","volume":"17","author":"Damluji","year":"2024","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.acvd.2020.12.002","article-title":"Antithrombotic strategies in elderly patients with acute coronary syndrome","volume":"114","author":"Dillinger","year":"2021","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"953","DOI":"10.3324\/haematol.2014.106260","article-title":"Platelet count and aging","volume":"99","author":"Balduini","year":"2014","journal-title":"Haematologica"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s00335-016-9629-8","article-title":"Platelet function and ageing","volume":"27","author":"Jones","year":"2016","journal-title":"Mamm. Genome"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102704","DOI":"10.1016\/j.rpth.2025.102704","article-title":"Elderly patients are hyperresponsive to potent P2Y12 inhibitors","volume":"9","author":"Mutschlechner","year":"2025","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1177\/000331979504600810","article-title":"The effect of ageing on platelet function and fibrinolytic activity","volume":"46","author":"Gleerup","year":"1995","journal-title":"Angiology"},{"key":"ref_11","first-page":"121390","article-title":"Aging-shifted prostaglandin profile in endothelium as a factor in cardiovascular disorders","volume":"2012","author":"Qian","year":"2012","journal-title":"J. AgingRes."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mazuryk, O., Gurgul, I., Oszajca, M., Polaczek, J., Kieca, K., Bieszczad-\u017bak, E., Martyka, T., and Stochel, G. (2024). Nitric Oxide Signaling and Sensing in Age-Related Diseases. Antioxidants, 13.","DOI":"10.3390\/antiox13101213"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rocha, B.S. (2021). The Nitrate-Nitrite-Nitric Oxide Pathway on Healthy Ageing: A Review of Pre-clinical and Clinical Data on the Impact of Dietary Nitrate in the Elderly. Front. Aging, 2.","DOI":"10.3389\/fragi.2021.778467"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s40140-021-00498-7","article-title":"Coagulation and Aging: Implications for the Anesthesiologist","volume":"11","author":"Tschan","year":"2021","journal-title":"Curr. Anesthesiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/j.jcin.2021.01.040","article-title":"Antithrombotic Management of Elderly Patients With Coronary Artery Disease","volume":"14","author":"Capranzano","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ahmed, B., Rahman, A.A., Lee, S., and Malhotra, R. (2024). The Implications of Aging on Vascular Health. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252011188"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s40495-025-00425-y","article-title":"Absorption to Excretion: The Aging Body\u2019s Take on Drugs\u2014A Review of Pharmacokinetic Changes and their Impact on Medication Management","volume":"11","author":"Ruiz","year":"2025","journal-title":"Curr. Pharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1258\/136218005775544589","article-title":"Drug metabolism and ageing","volume":"11","author":"Wynne","year":"2005","journal-title":"J. Br. Menopause Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e205","DOI":"10.3346\/jkms.2024.39.e205","article-title":"Polypharmacy and Elevated Risk of Severe Adverse Events in Older Adults Based on the Korea Institute of Drug Safety and Risk Management-Korea Adverse Event Reporting System Database","volume":"39","author":"Kim","year":"2024","journal-title":"J. Korean Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4789","DOI":"10.1111\/bcp.15371","article-title":"Does coprescribing nonsteroidal anti-inflammatory drugs and oral anticoagulants increase the risk of major bleeding, stroke and systemic embolism?","volume":"88","author":"Penner","year":"2022","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1053\/j.seminhematol.2008.06.006","article-title":"Epidemiology of anemia in older adults","volume":"45","author":"Patel","year":"2008","journal-title":"Semin. Hematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1182\/blood.V78.1.154.154","article-title":"Erythrocytes metabolically enhance collagen-induced platelet responsiveness via increased thromboxane production, adenosine diphosphate release, and recruitment","volume":"78","author":"Valles","year":"1991","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jash.2011.06.001","article-title":"ACCF\/AHA 2011 expert consensus document on hypertension in the elderly: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension","volume":"5","author":"Aronow","year":"2011","journal-title":"J. Am. Soc. Hypertens."},{"key":"ref_24","first-page":"637","article-title":"Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral haemorrhage: Evidence of microangiopathy-related microbleeds","volume":"20","author":"Fazekas","year":"1999","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Giovannini, S., Brau, F., Galluzzo, V., Santagada, D.A., Loreti, C., Biscotti, L., Laudisio, A., Zuccal\u00e0, G., and Bernabei, R. (2022). Falls among Older Adults: Screening, Identification, Rehabilitation, and Management. Appl. Sci., 12.","DOI":"10.3390\/app12157934"},{"key":"ref_26","first-page":"3238","article-title":"Antithrombotic therapy in the elderly: Expert position paper of the European Society of Cardiology Working Group on Thrombosis","volume":"36","author":"Andreotti","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"10361046","DOI":"10.1016\/S0140-6736(18)31924-X","article-title":"Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): A randomised, double-blind, placebo-controlled trial","volume":"392","author":"Gaziano","year":"2018","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"ASCEND Study Collaborative Group, Bowman, L., Mafham, M., Wallendszus, K., Stevens, W., Buck, G., Barton, J., Murphy, K., Aung, T., and Haynes, R. (2018). Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N. Engl. J. Med., 379, 15291539.","DOI":"10.1056\/NEJMoa1804988"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3121\/cmr.2020.1548","article-title":"Aspirin in Primary Prevention of Cardiovascular Events","volume":"18","author":"Soodi","year":"2020","journal-title":"Clin. Med. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1056\/NEJMoa1805819","article-title":"Effect of aspirin on cardiovascular events and bleeding in the healthy elderly","volume":"379","author":"McNeil","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1056\/NEJMoa1800722","article-title":"Effect of aspirin on disability-free survival in the healthy elderly","volume":"379","author":"McNeil","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e177","DOI":"10.1016\/j.jacc.2019.03.010","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"74","author":"Arnett","year":"2019","journal-title":"J. Am. Coll.Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Laudani, C., Giacoppo, D., Greco, A., Ortega-Paz, L., El Khoury, G., Capodanno, D., and Angiolillo, D.J. (2025). Antiplatelet Monotherapies for Long-Term Secondary Prevention Following Percutaneous Coronary Intervention. J. Clin. Med., 14.","DOI":"10.3390\/jcm14155536"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12959-023-00559-3","article-title":"Progress in the clinical effects and adverse reactions of ticagrelor","volume":"22","author":"Wei","year":"2024","journal-title":"Thromb. J."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hu, X., Wang, W., Ye, J., Lin, Y., Yu, B., Zhou, L., Zhou, Y., and Dong, H. (2021). Effect of GP IIb\/IIIa inhibitor duration on the clinical prognosis of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction with no-\/slow-reflow phenomenon. Biomed. Pharmacother., 143.","DOI":"10.1016\/j.biopha.2021.112196"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.jacc.2021.08.013","article-title":"Bridging antiplatelet therapy after percutaneous coronary intervention: JACC review topic of the week","volume":"78","author":"Sullivan","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2318","DOI":"10.1056\/NEJMoa0908628","article-title":"Platelet inhibition with cangrelor in patients undergoing PCI","volume":"361","author":"Harrington","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1056\/NEJMoa1300815","article-title":"Effect of platelet inhibition with cangrelor during PCI on ischemic events","volume":"368","author":"Bhatt","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1056\/NEJMoa0908629","article-title":"Intravenous platelet blockade with cangrelor during PCI","volume":"361","author":"Bhatt","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1016\/S0140-6736(13)61615-3","article-title":"Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: A pooled analysis of patient-level data","volume":"382","author":"Steg","year":"2013","journal-title":"Lancet"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.amjcard.2024.12.021","article-title":"Use of Cangrelor in Older Patients: Findings from the itAlianpRospective Study on CANGrELOr Study","volume":"240","author":"Capranzano","year":"2025","journal-title":"Am. J. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1056\/NEJMoa010746","article-title":"Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation","volume":"345","author":"Yusuf","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1056\/NEJMoa0706482","article-title":"Prasugrel versus clopidogrel in patients with acute coronary syndromes","volume":"357","author":"Wiviott","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","article-title":"Ticagrelor versus clopidogrel in patients with acute coronary syndromes","volume":"361","author":"Wallentin","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1177\/0091270009337942","article-title":"Population pharmacokinetic analyses to evaluate the influence of intrinsic and extrinsic factors on exposure of prasugrel active metabolite in TRITON-TIMI 38","volume":"49","author":"Wrishko","year":"2009","journal-title":"J. Clin. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jacc.2013.05.023","article-title":"Prasugrel 5 mg in the very elderly attenuates platelet inhibition but maintains noninferiority to prasugrel 10 mg in nonelderly patients: The GENERATIONS trial, a pharmacodynamic and pharmacokinetic study in stable coronary artery disease patients","volume":"62","author":"Erlinge","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1161\/CIRCULATIONAHA.113.002303","article-title":"Elderly patients with acute coronary syndromes managed without revascularization: Insights into the safety of long-term dual antiplatelet therapy with reduced-dose prasugrel versus standard dose clopidogrel","volume":"128","author":"Roe","year":"2013","journal-title":"Circulation"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1161\/CIRCULATIONAHA.117.032180","article-title":"Comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization","volume":"137","author":"Savonitto","year":"2018","journal-title":"Circulation"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1016\/j.jacc.2018.09.057","article-title":"ACC\/AHA versus ESC guidelines on dual antiplatelet therapy: JACC guideline comparison","volume":"72","author":"Capodanno","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e012530","DOI":"10.1161\/JAHA.119.012530","article-title":"Efficacy and safety of ticagrelor in comparison to clopidogrel in elderly patients with ST-segment elevation myocardial infarctions","volume":"8","author":"Schmucker","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1161\/CIRCULATIONAHA.120.050645","article-title":"Comparison between ticagrelor and clopidogrel in elderly patients with an acute coronary syndrome\u2014Insights from the SWEDEHEART registry","volume":"42","author":"Szummer","year":"2020","journal-title":"Circulation"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/S0140-6736(20)30325-1","article-title":"Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-STelevation acute coronary syndrome (POPular AGE): The randomised, open-label, non-inferiority trial","volume":"395","author":"Gimbel","year":"2020","journal-title":"Lancet"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0140-6736(17)30397-5","article-title":"PRECISE-DAPT Study Investigators. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: A pooled analysis of individual-patient datasets from clinical trials","volume":"389","author":"Costa","year":"2017","journal-title":"Lancet"},{"key":"ref_56","first-page":"101168","article-title":"Frailty prevalence, invasive treatment frequency, and in-hospital outcome in patients hospitalized for acute coronary syndrome in Germany (2005\u20132022): A nationwide registry study","volume":"49","author":"Kellner","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1093\/eurheartj\/ehv531","article-title":"Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction: Insights from PEGASUS-TIMI 54","volume":"37","author":"Bonaca","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"78","DOI":"10.4244\/EIJ-D-16-00497","article-title":"Ischaemic and bleeding outcomes in elderly patients undergoing a prolonged versus shortened duration of dual antiplatelet therapy after percutaneous coronary intervention: Insights from the PRODIGY randomised trial","volume":"13","author":"Piccolo","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1093\/eurheartj\/ehu523","article-title":"ISAR-SAFE: A randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting","volume":"36","author":"Byrne","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.jacc.2015.01.039","article-title":"Duration of dual antiplatelet therapy after drug-eluting stent implantation: A systematic review and meta-analysis of randomized controlled trials","volume":"65","author":"Giustino","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"550","DOI":"10.4244\/EIJ-D-24-00973","article-title":"Ticagrelor monotherapy versus ticagrelor plus aspirin in patients with chronic coronary syndrome and high ischaemic risk: A post hoc analysis of the TWILIGHT trial","volume":"21","author":"Gitto","year":"2025","journal-title":"EuroIntervention"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/j.jcin.2025.01.424","article-title":"1-Month or 3-Month DAPT in Women and Men at High Bleeding Risk Undergoing PCI","volume":"18","author":"Kunadian","year":"2025","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.4070\/kcj.2025.0093","article-title":"Comparison of Short-term and Standard Duration Dual Antiplatelet Therapy in Elderly Patients: A Pooled Analysis of Five Korean Randomized Clinical Trials","volume":"55","author":"Jin","year":"2025","journal-title":"Korean Circ. J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"100389","DOI":"10.1016\/j.jacadv.2023.100389","article-title":"Assessment and management of older aults undergoing PCI, Part 1. A JACC: Advances Expert Panel","volume":"2","author":"Nana","year":"2023","journal-title":"JACC Adv."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1111\/jcpt.13508","article-title":"Prevalence and the factors associated with oral anticoagulant use among nursing home residents","volume":"46","author":"Chen","year":"2021","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1093\/eurheartj\/ehi825","article-title":"Prevalence, incidence and lifetime risk of atrial fibrillation: The Rotterdam study","volume":"27","author":"Heeringa","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1001\/jama.285.18.2370","article-title":"Prevalence of diagnosed atrial fibrillation in adults national implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) study","volume":"285","author":"Go","year":"2001","journal-title":"JAMA"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the european association for cardio-thoracic surgery (EACTS): The task force for the diagnosis and management of atrial fibrillation of the european society of cardiology (ESC) developed with the special contribution of the european heart rhythm association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"4693","DOI":"10.1182\/bloodadvances.2020001830","article-title":"American society of hematology 2020 guidelines for management of venous thromboembolism: Treatment of deep vein thrombosis and pulmonary embolism","volume":"4","author":"Ortel","year":"2020","journal-title":"Blood Adv."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1093\/europace\/euab065","article-title":"2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation","volume":"23","author":"Steffel","year":"2021","journal-title":"Europace"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.thromres.2024.04.009","article-title":"Oral anticoagulant therapy in older adults","volume":"238","author":"Stuby","year":"2024","journal-title":"Thromb. Res."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1103.e1","DOI":"10.1016\/j.jamda.2015.09.008","article-title":"Clinical and safety outcomes of oral antithrombotics for stroke prevention in atrial fibrillation: A systematic review and network meta-analysis","volume":"16","author":"Lin","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1016\/j.jamda.2023.05.010","article-title":"Efficacy and safety of oral anticoagulants in older adult patients with atrial fibrillation: Pairwise and network meta-analyses","volume":"24","author":"Wang","year":"2023","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Grymonprez, M., De Backer, T.L., Bertels, X., Steurbaut, S., and Lahousse, L. (2023). Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation: A nationwide cohort study. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1125576"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1056\/NEJMoa2012883","article-title":"Low dose edoxaban in very elderly patients with atrial fibrillation","volume":"383","author":"Okumura","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e2228500","DOI":"10.1001\/jamanetworkopen.2022.28500","article-title":"Outcomes and safety of very-low-dose edoxaban in frail patients with atrial fibrillation in the ELDERCARE-AF randomized clinical trial","volume":"5","author":"Akashi","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"AGS (2023). American geriatrics society 2023 updated AGS beers criteria\u00ae for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc., 71, 2052\u20132081.","DOI":"10.1111\/jgs.18372"},{"key":"ref_79","first-page":"279","article-title":"Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation: Results of the FRAIL-AF randomized controlled trial","volume":"149","author":"Joosten","year":"2023","journal-title":"Circulation"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1161\/CIRCULATIONAHA.122.062353","article-title":"Pharmacology and Clinical Development of Factor XI Inhibitors","volume":"147","author":"Greco","year":"2023","journal-title":"Circulation"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40119-024-00352-x","article-title":"Factor XI Inhibitors: A New Horizon in Anticoagulation Therapy","volume":"13","author":"Presume","year":"2024","journal-title":"Cardiol. Ther."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.jacc.2022.11.057","article-title":"Clinical Evaluation of Factor XIa Inhibitor Drugs","volume":"81","author":"Harrington","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"B65","DOI":"10.1093\/eurheartjsupp\/suad070","article-title":"The new in anticoagulation: Factor XI inhibitors","volume":"25","author":"Muscente","year":"2023","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1016\/S0140-6736(22)00456-1","article-title":"Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): A multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study","volume":"399","author":"Piccini","year":"2022","journal-title":"Lancet"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa2407105","article-title":"Asundexian versus Apixaban in Patients with Atrial Fibrillation","volume":"392","author":"Piccini","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S1474-4422(23)00403-9","article-title":"Safety and efficacy of factor XIa inhibition with milvexian for secondary stroke prevention (AXIOMATIC-SSP): A phase 2, international, randomised, double-blind, placebo-controlled, dose-finding trial","volume":"23","author":"Sharma","year":"2024","journal-title":"Lancet Neurol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1056\/NEJMoa2113194","article-title":"Milvexian for the prevention of venous thromboembolism","volume":"385","author":"Weitz","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1056\/NEJMoa2105872","article-title":"ANT-005 TKA Investigators. Abelacimab for prevention of venous thromboembolism","volume":"385","author":"Verhamme","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1056\/NEJMoa2406674","article-title":"Abelacimab versus Rivaroxaban in Patients with Atrial Fibrillation","volume":"392","author":"Ruff","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_90","unstructured":"Janssen Research & Development, LLC (2023, September 01). An Open-Label, Randomized, Crossover Study to Evaluate the Relative Oral Bioavailability, Pharmacokinetics, and Food Effect After Single Dose (for Part 1, Part 3, Part 4 and Part 5) or Multiple-Dose (for Part 2) Administration of JNJ-70033093 (Milvexian) in Healthy Adult Participants Using Tablet, Capsule and Dispersed Tablet Formulations, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04844424."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"100179","DOI":"10.1016\/j.crphar.2024.100179","article-title":"A leap forward in anticoagulation with FXI and FXIa Inhibition","volume":"6","author":"Badreldin","year":"2024","journal-title":"Curr. Res. Pharmacol. Drug Discov."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s12170-016-0491-8","article-title":"Multimorbidity in Older Patients with Cardiovascular Disease","volume":"10","author":"Dunlay","year":"2016","journal-title":"Curr. Cardiovasc. Risk Rep."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Castiello, D.S., Buongiorno, F., Manzi, L., Narciso, V., Forzano, I., Florimonte, D., Sperandeo, L., Canonico, M.E., Avvedimento, M., and Paolillo, R. (2025). Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12040142"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1093\/eurheartj\/ehq117","article-title":"Antithrombotic management of atrial fibrillation patients presenting with acute coronary syndrome and\/or undergoing coronary stenting: Executive summary\u2014A Consensus Document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association (EHRA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)","volume":"31","author":"Lip","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1161\/CIRCULATIONAHA.112.114967","article-title":"Bleeding After Initiation of Multiple Antithrombotic Drugs, Including Triple Therapy, in Atrial Fibrillation Patients Following Myocardial Infarction and Coronary Intervention","volume":"126","author":"Lamberts","year":"2012","journal-title":"Circulation"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.jacc.2015.05.062","article-title":"Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation","volume":"66","author":"Hess","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/S0140-6736(12)62177-1","article-title":"Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: An open-label, randomised, controlled trial","volume":"381","author":"Dewilde","year":"2013","journal-title":"Lancet"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1056\/NEJMoa1611594","article-title":"Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI","volume":"375","author":"Gibson","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1056\/NEJMoa1708454","article-title":"Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation","volume":"377","author":"Cannon","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/S0140-6736(19)31872-0","article-title":"Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): A randomised, open-label, phase 3b trial","volume":"394","author":"Vranckx","year":"2019","journal-title":"Lancet"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1056\/NEJMoa1817083","article-title":"Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation","volume":"380","author":"Lopes","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s10557-018-6795-9","article-title":"Ticagrelor Versus Clopidogrel as Part of Dual or Triple Antithrombotic Therapy: A Systematic Review and Meta-Analysis","volume":"32","author":"Andreou","year":"2018","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"3757","DOI":"10.1093\/eurheartj\/ehz732","article-title":"Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: A systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials","volume":"40","author":"Gargiulo","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e656","DOI":"10.4244\/EIJ-D-21-01044","article-title":"Antithrombotic strategy variability in atrial fibrillation and obstructive coronary disease revascularised with percutaneous coronary intervention: Primary results from the AVIATOR 2 international registry","volume":"18","author":"Chandrasekhar","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1093\/ehjcvp\/pvaa088","article-title":"Combinations of antithrombotic therapies prescribed after percutaneous coronary intervention in patients with acute coronary syndromes and atrial fibrillation: Data from the nationwide MATADOR-PCI registry","volume":"7","author":"Bolognese","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/FJC.0000000000001607","article-title":"Management of Patients Treated With Oral Anticoagulant Therapy Undergoing Percutaneous Coronery Intervention With Stent Implantation: The PERSEO Registry","volume":"84","author":"Sciahbasi","year":"2024","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.26599\/1671-5411.2025.08.002","article-title":"Clinical characteristics, therapeutic strategies, and outcomes in elderly patients on oral anticoagulant therapy undergoing percutaneous coronary interventions: Post-hoc analysis of the PERSEO Registry","volume":"22","author":"Minardi","year":"2025","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"e898","DOI":"10.4244\/EIJ-D-24-00100","article-title":"Temporary omission of oral anticoagulation in atrial fibrillation patients undergoing percutaneous coronary intervention: Rationale and design of the WOEST-3 randomised trial","volume":"20","author":"Verburg","year":"2024","journal-title":"EuroIntervention"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"C254","DOI":"10.1093\/eurheartj\/suac020","article-title":"ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and\/or acute coronary syndromes","volume":"24","author":"Rubboli","year":"2022","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"738","DOI":"10.2459\/JCM.0000000000001372","article-title":"Design of PERSEO Registry on the management of patients treated with oral anticoagulants and coronary stent","volume":"23","author":"Sciahbasi","year":"2022","journal-title":"J. Cardiovasc. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7340\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:05:23Z","timestamp":1760965523000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":111,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207340"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207340","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}