Continued Age-Related Pharmacological Change Clinical Effect Dose-Adjustment Recommendations Additional Precautions (Continued) Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e425 GP IIb/IIIa Inhibitors (continued) Eptifibatide Weight/renally dosed Bleeding risk Weight-based: 180 mcg/kg loading dose + 2 mcg/kg/min INF; CrCl 50 mL/min: 1.0 mcg/kg/min INF Less benefit/more bleeding with age Tirofiban Weight/renally dosed Bleeding risk Weight-based: 12 mcg/kg loading dose + 0.14 mcg/kg/min INF; CrCl <30 mL/min: 6 mcg/kg loading dose + 0.05 mcg/kg/min INF In older pts with high bleeding risk, low-dose INF effective with bleeding Warfarin Sensitivity; 20% 40% clearance; protein binding; inhibition vitamin K-dependent clotting factors at same plasma levels with age Bleeding risk at lower INR; higher INR/dose with age risk GI bleeding Loading: 4 mg/d 4 d Maintain mean dose 0.4 mg/w/y of age Multiple drug interactions, frequency of monitoring; ASA potentiates effect New Oral AC N/A N/A Contraindicated if CrCl If pt taking when admitted, stop consider delaying angiogram/ PCI until effect wanes, switch to UFH/dalteparin/bivalirudin/ fondaparinux; AP and DAPT bleeding 2 post-ACS consider BMS and radial access. Avoid GP IIb/IIIa inhibitor if possible; thrombotic risk following discontinuation. 