Antiplatelet agents and arterial thrombosis

It seems justified and reasonable to prescribe low-dose aspirin for all geriatric patients, and for patients with peripheral arterial disease, clopidogrel for primary prevention. There is, at present, no place for the addition of dipyridamole or oral GPIIb-IIIa antagonists. GPIIb-IIIa antagonists may be indicated in acute events, requiring intervention. Whether patients should be screened for aspirin tolerance or resistance is not clear, but it may be prudent to place patients who fail therapy on a second antiplatelet agent, such as clopidogrel. There is no evidence to suggest that the increase in bleeding that may occur in the elderly should suggest that therapy be withheld and, indeed, there is some evidence that the elderly may derive a relatively increased benefit from the use of these antiplatelet agents.