Polypragmasy in elderly and senile patients with chronic kidney disease: START/STOP criteria in elderly and senile patients taking DOAC

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  • Authors: Kondrakhin A.P.1,2, Silina E.G.3, Chernyaeva M.S.2,4, Maksimov M.L.1,5,6, Babichev A.N.1, Smirnova Y.E.1, Martynova S.A.1, Schnаider K.O.1,6
  • Affiliations:
    1. Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation
    2. Moscow State Budgetary Healthcare Institution “Hospital for War Veterans No.2 of the Moscow City Healthcare Department”
    3. Federal State Budgetary Educational Institution of Higher Education “Russian University of Medicine” of The Ministry of Health of the Russian Federation
    4. Federal State Budgetary Institution of Continuing Professional Education “Central State Medical Academy” of the Administrative Department of the President of the Russian Federation
    5. Kazan State Medical Academy – branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia
    6. Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education”, Ministry of Health of Russia
  • Issue: Vol 23, No 5 (2025)
  • Pages: 49-60
  • Section: Original research
  • URL: https://journals.eco-vector.com/1728-2918/article/view/696271
  • DOI: https://doi.org/10.29296/24999490-2025-05-07
  • ID: 696271

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Abstract

Introduction. Thanks to the achievements of modern medicine, it was possible to significantly increase the life expectancy of the population. Molecular mechanisms of aging include telomere shortening, DNA damage accumulation, mitochondrial dysfunction, leading to decreased functional reserves of organs and systems. The cohort of geriatric patients is at risk of polypragmasy and has features of drug pharmacokinetics.

Objective: To evaluate factors that increase the risk of taking direct oral anticoagulants in elderly patients with polypragmasy and chronic kidney disease taking into account molecular mechanisms of drug action and individual pharmacogenetic features.

Material and methods. For this study, a database of 503 patients seen in «GVH No.2 DZM» from April to September 2023 was collected. The method of questionnaire was used, as well as the collection of clinical and laboratory data allowing to evaluate DOAC-dependent complications – cases of bleeding, duration of DOAC administration. Additionally, renal function biomarkers (cystatin C, NGAL), coagulation parameters and CYP3A4/CYP2C19 activity by indirect markers were analyzed.

Results. DOAC administration increases bleeding risks when creatinine clearance is significantly decreased, especially when dabigatran is administered. Administration of apixaban and rivaroxaban have no statistically significant increase in the incidence of hemorrhagic complications as renal impairment progresses. Concomitant DOAC and heparins significantly increase the risk of bleeding during 1 year of therapy. Co-administration of dabigatran and verapamil increases the risk of bleeding, which is not seen with other DOACs.

Conclusion. Investigation of drug interactions and the association of DOAC intake with various endpoints in larger samples will help to identify predictors of adverse outcomes and adjust therapy. Personalized approach considering pharmacogenetic features and molecular biomarkers can significantly improve the safety of anticoagulant therapy in elderly patients.

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About the authors

Andrey Petrovich Kondrakhin

Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation; Moscow State Budgetary Healthcare Institution “Hospital for War Veterans No.2 of the Moscow City Healthcare Department”

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

Candidate of Medical Sciences, Senior Lecturer, Pharmacology Department, Institute of Pharmacy and Medical Chemistry, Chief Specialist, Clinical Pharmacology, South-Eastern Administrative District, Moscow Health Department, Clinical Pharmacologist

Russian Federation, Ostrovityanova str., 1, Moscow, 117997; Volgogradskiy Prospekt, 168, Moscow, 109472

Elena Gennadievna Silina

Federal State Budgetary Educational Institution of Higher Education “Russian University of Medicine” of The Ministry of Health of the Russian Federation

Email: kafedrakf@mail.ru
ORCID iD: 0000-0003-0406-3888
SPIN-code: 2245-4442

Candidate of Medical Sciences, Associate Professor, Department of Therapy, Clinical Pharmacology and Emergency Medical Care

Russian Federation, Dolgorukovskaya st., 4, Moscow, 127006

Marina Sergeevna Chernyaeva

Moscow State Budgetary Healthcare Institution “Hospital for War Veterans No.2 of the Moscow City Healthcare Department”; Federal State Budgetary Institution of Continuing Professional Education “Central State Medical Academy” of the Administrative Department of the President of the Russian Federation

Email: doctor@cherniaeva.ru
ORCID iD: 0000-0003-3091-7904
SPIN-code: 2244-0320

Candidate of Medical Sciences, Head of the Geriatric Department, Associate Professor, Department of Internal Diseases and Preventive Medicine

Russian Federation, Volgogradskiy Prospekt, 168, Moscow, 109472; Marshal Timoshenko St., 19, build. 1A, Moscow, 121359

Maksim Leonidovich Maksimov

Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation; Kazan State Medical Academy – branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia; Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education”, Ministry of Health of Russia

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

Doctor of Medical Sciences, Professor, Professor of the Department of Pharmacology of the Institute of Pharmacy and Medical Chemistry, Head of the Department of Clinical Pharmacology and Pharmacotherapy, Kazan State Medical Academy, Dean of the Faculty of Preventive Medicine and Health Organization

Russian Federation, Ostrovityanova str., 1, Moscow, 117997; Butlerova st., 49, Kazan, Republic of Tatarstan, 420012; Barrikadnaya st., 2/1, Moscow, 123995

Artem Nikolaevich Babichev

Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation

Email: brain000storm@gmail.com
ORCID iD: 0009-0001-4826-3411

4rd year student of the Institute of Clinical Medicine

Russian Federation, Ostrovityanova str., 1, Moscow, 117997

Yulia Evgenievna Smirnova

Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation

Email: yuliya18_04@mail.ru
ORCID iD: 0009-0002-1358-6752

4rd year student at the Institute of Motherhood and Childhood

Russian Federation, Ostrovityanova str., 1, Moscow, 117997

Sofya Alekseevna Martynova

Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation

Email: sofya.martynova2014@yandex.ru
ORCID iD: 0009-0000-0343-0848

5rd year student at the Institute of Motherhood and Childhood

Russian Federation, Ostrovityanova str., 1, Moscow, 117997

Ksenia Olegovna Schnаider

Federal State Autonomous Educational Institution of Higher Education “Russian National Research Medical University named after N.I. Pirogov” of the Ministry of Health of the Russian Federation; Federal State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Continuous Professional Education”, Ministry of Health of Russia

Email: ks.shnaider@mail.ru
ORCID iD: 0000-0002-0630-4238
SPIN-code: 9979-2700

assistant at the Department of Pharmacology at the Institute of Pharmacy and Medical Chemistry, and an assistant at the Department of Pharmacy, General Pharmacology, and Pharmaceutical Counseling

Russian Federation, Ostrovityanova str., 1, Moscow, 117997; Barrikadnaya st., 2/1, Moscow, 123995

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Number of drugs taken

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3. Fig. 2. Popularity of prescribing various drug groups together with DOAC

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4. Fig. 3. Distribution of patients by CKD stages

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5. Fig. 4. Distribution of the drug taken among patients with GFR<45 ml/min/1.73m2

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