Bleeding risk in elderly patients undergoing percutaneous coronary intervention: a comprehensive review

Abstract

The care of elderly patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs) presents unique challenges due to age-related physiological and functional changes. With the global population aging rapidly, this de mographic change affects a growing proportion of individuals requiring PCI. However, advanced age is associated with increased susceptibility to ischemic and bleeding complica tions, driven by physiological changes such as altered coagulation, vascular stiffness, and declining organ function. These factors complicate the management of CAD, making the balance between reducing thrombotic events and minimizing bleeding risks particularly challenging. Antiplatelet therapy is central to post-PCI management, but its benefits and risks differ significantly in elderly patients compared to younger populations. Tools like the PRECISE-DAPT and ARC-HBR provide guidance on dual antiplatelet therapy duration and bleeding risk stratification. However, their applicability and predictive accuracy in elderly patients remain areas of active investigation. This underscores the need for im proved risk assessment methods tailored to the unique needs of aging individuals. In this review, we explore the epidemiological, pathophysiological, and clinical aspects of CAD in elderly patients, emphasizing the impact of aging on disease presentation and outcomes. Furthermore, we assess current risk stratification tools and discuss their limitations in predicting adverse events in older populations. By synthesizing these insights, we aim to highlight the complexities of managing elderly CAD patients and identify opportunities for optimizing personalized care to achieve better outcomes in this vulnerable group.