AC indicates anticoagulants; ACE, angiotensin-converting-enzyme; ACS, acute coronary syndromes; ADR, adverse drug reactions; AKI, acute kidney injury; AP, antiplatelets; aPTT, activated partial thromboplastin time; ARB, angiotensin receptor blocker; ASA, aspirin; AT, antithrombins; AV, atrioventricular; BID, twice daily; BMS, bare-metal stent; BP, blood pressure; CCBs, calcium channel blockers; CrCl, creatinine clearance; DAPT, dual antiplatelet therapy; DHP, dihydropyridine; EC, extracellular; GFR, glomerular filtration rate; GI, gastrointestinal; GP, glycoprotein; HPR, high platelet reactivity; HR, heart rate; INF, infusion; INR, international normalized ratio; K+ , potassium; LMWH, low-molecular-weight heparin; max, maximum; Mg, magnesium; N/A, not available; NSAIDs, nonsteroidal anti-inflammatory drugs; NSTE-ACS, non-ST-elevation acute coronary syndromes; OH, orthostatic hypotension; PCI, percutaneous coronary intervention; pts, patients; QD; once daily; SA, sinoatrial; SC, subcutaneous; SCr, serum creatinine; T , half-life; and UFH, unfractionated heparin. Table B. Continued Age-Related Pharmacological Change Clinical Effect Dose-Adjustment Recommendations Additional Precautions Table C. Age-Related Physiological Changes: Clinical Impact in Older Patients With NSTE-ACS Age-Related Change Clinical Alteration Clinical Impact in NSTE-ACS Central arterial stiffness SBP/ DBP; LVH; diastolic function; coronary perfusion pressure; ischemia/infarct threshold for tachycardia/hypertension with and without coronary obstructive disease; PA pressure Risk end-organ damage (cerebrovascular accident, AKI); BP lability; reinfarction/ischemia; orthostatic hypotension; HF; pulmonary edema LV diastolic function LA size; early passive LV filling; late LV filling and LV EDP; PA pressure Risk AF; ( pulmonary edema/ CO), DOE; pulmonary edema with HR/ BP Response to beta-adrenergic stimulation HR/ inotropic responsiveness to stress; resting systolic LV function unchanged with age Hypotension, HF, HR response Conduction system changes Sinus node cells; AV conduction; LBBB; and RBBB Difficult to interpret electrocardiographic MI/ischemia; heart block; SSS; SVT, sensitivity to conduction system drugs Volume regulating hormones Na, K, and water regulation BP lability Altered electrolytes, sensitivity to fluid therapy/diuretics Renal changes GFR (0.8 mL/min/y), Na/K clearance, normal serum creatinine despite moderate to severe CKD, altered drug clearance; urine concentrating ability CrCl or eGFR must be calculated for drug dosing, sensitivity to contrast nephropathy, risk AKI Fat-muscle redistribution Third spacing of fluid, may alter drug storage; Vo2max May alter fluid/drug dosing, decreased CO; DOE; early fatigability Baroreceptor sensitivity BP lability Orthostatic hypotension, fall risk Clotting factor/platelet function/hemostasis Bleeding and clotting risk, sensitivity to anticoagulants/antithrombins Risk cerebrovascular accident/reinfarction/recurrent ischemia, bleeding, thrombosis, PE, DVT; may alter drug dosing/sensitivity; stent thrombosis AF indicates atrial fibrillation; AKI, acute kidney injury; AV, atrioventricular; BP, blood pressure; CKD, chronic kidney disease; CO, cardiac output; CrCl, creatinine clearance; DBP, diastolic blood pressure; DOE, dyspnea on exertion; DVT, deep vein thrombosis; EDP, end-diastolic pressure; eGFR, estimated glomerular filtration rate; GFR, glomerular filtration rate; HF, heart failure; HR, heart rate; K, potassium; LA, left atrium; LBBB, left bundle-branch block; LV, left ventricular; LVH, left ventricular hypertrophy; MI, myocardial infarction; NA, sodium; Na/K sodium and potassium clearance; NTSE-ACS, non ST-elevation acute coronary syndrome; PA, pulmonary artery; PE, pulmonary embolism; RBBB, right bundle-branch block, SBP, systolic blood pressure; SSS, sick sinus syndrome; SVT, supraventricular tachycardia; and Vo2max , maximum oxygen consumption. 