Direct oral anticoagulants prescription in the elderly: predictors of adverse outcomes

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Abstract

Introduction. Due to the increasing number of geriatric patients, there is a need to improve the results of direct oral anticoagulants (POAC) use in this group – increasing the safety of drug administration, evaluation of predictors of POAC-dependent complications.

Aim – to report on possible predictors of adverse outcomes of oral anticoagulants (POACs) in the elderly.

Material and Methods. The study included 272 elderly patients with C3a-C4 chronic kidney disease (CKD). We evaluated POAC intake violation, as well as complications, their relation to the facts obtained by questionnaire and laboratory methods of investigation.

Results. The main POAK-dependent complication was "minor bleeding", which in some cases led to drug withdrawal (which could increase the risk of thromboembolic complications), however, independent drug withdrawal was quite rare and was not a reliable predictor of adverse outcomes. Nevertheless, the incidence of nosebleeds was correlated with serum creatinine level, CKF, and arterial hypertension. Apixaban was associated with a lower incidence of complications per analysis.

Conclusion. Complications per assay associated with POAC administration were more common with an ICF below 45 mL/min. Serum creatinine, stage of CKD and degree of arterial hypertension are parameters whose control may reduce the incidence of POAC-dependent complications.

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About the authors

A. P. Kondrakhin

Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; State Budgetary Institution of Healthcare of Moscow "Hospital for War Veterans No. 2 of the Moscow City Health Department"

Author for correspondence.
Email: 79104851199@yandex.ru
ORCID iD: 0000-0002-3439-8059
SPIN-code: 1402-2947

Ph.D. (Med.), Chief Specialist of the Moscow City Health Department for Clinical Pharmacology
of the South-Eastern Administrative District of Moscow, Clinical Pharmacologist, Senior Lecturer of the Pharmacology Department of the Institute of Pharmacy and Medical Chemistry

Russian Federation, st. Ostrovityanova, 1, Moscow, 117513; Volgogradsky Prospekt, 168, Moscow, 109472

M. L. Maksimov

Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation

Email: maksim_maksimov@mail.ru
ORCID iD: 0000-0002-8979-8084
SPIN-code: 6261-3982

Kazan State Medical Academy, Dr.Sc. (Med.), Professor, Head of the Department of Clinical Pharmacology and Pharmacotherapy, Professor of the Department of Pharmacology, Dean of the Faculty of Preventive Medicine and Healthcare Organization

Russian Federation, st. Ostrovityanova, 1, Moscow, 117513; 2/1, building 1, Barrikadnaya st., Moscow, 125993; Butlerova street, 36, Tukay square, Kazan, 420012

I. V. Sychev

Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation

Email: sychev_iv@bk.ru
ORCID iD: 0000-0003-0227-2651

Junior Research Scientist, Research Institute of Molecular and Personalized Medicine

Russian Federation, 2/1, building 1, Barrikadnaya st., Moscow, 125993

K. O. Shnaider

Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: 79104851199@yandex.ru
ORCID iD: 0000-0002-0630-4238
SPIN-code: 9979-2700

Assistent

Russian Federation, st. Ostrovityanova, 1, Moscow, 117513

N. G. Paskar

I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation

Email: nnikpaskar@yandex.ru
ORCID iD: 0009-0002-6656-6667
SPIN-code: 8269-0440

Student of the A.P. Nelyubin Institute of Pharmacy

Russian Federation, 8/2, Trubetskaya str., Mosсow, 119991

References

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Supplementary files

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2. Fig. 1. Distribution by stage of chronic kidney disease

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3. Fig. 2. Distribution of patients by the DOAC drug taken in the study group of elderly people

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4. Fig. 3. Duration of direct oral anticoagulants intake

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5. Fig. 4. Main complications associated with direct oral anticoagulants intake

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6. Fig. 5. Discontinuation of direct oral anticoagulants

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7. Fig. 6. Complications for analysis and their distribution depending on the stage of chronic kidney disease

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