As older patients are under- represented in clinical trials, the recommendations in this CPG are largely supported by registry data and meta-analyses.516,537 Older patients with NSTE-ACS primarily present with chest pain but frequently have atypical symptoms. ECGs may be less diagnostic than in younger patients.517,538 Older patients with NSTE-ACS derive the same or greater benefit from phar- macological therapies, interventional therapies, and cardiac rehabilitation as younger patients, but older patients receive significantly less GDMT than younger patients, even when adjusted for comorbidities.515 517,535,538,539 In the ACSIS (Acute Coronary Syndrome Israeli Survey) registry, patients >80 years of age referred for early coronary angiography, compared with no angiography, had lower 30-day and 1-year mortality rates.540 Age-related pharmacokinetics and pharmacodynamic changes can alter drug dosing, efficacy, and safety of many NSTE-ACS therapies, as can drug drug interactions CrCl or glomerular filtra- tion rate (GFR) should be estimated initially and throughout care for all older patients with NSTE-ACS, and pharmaceuti- cal agents should be renally and weight dose-adjusted to limit drug toxicity (especially bleeding risk), given the unreliabil- ity of serum creatinine to assess age-related renal dysfunc- (Appendix 4, Table C). Bleeding in older patients with NSTE-ACS is multifactorial, resulting in nar- rower therapeutic windows.541,542,544,546,547 In the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With **Those 75 years of age (see text). Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e383 Early Implementation of the American College of Cardiology/ American Heart Association Guidelines) study, excessive doses of UFH, LMWH, and GP IIb/IIIa inhibitors accounted Aspirin should be maintained at 81 mg per day (after initial stent implantation). 