Resumen de Dose adjustment of direct oral anticoagulants dose in elderly institutionalized patients
Claudia Leralta González, Virginia Sanz Alonso, Jesica Nuñez Rodríguez, Alicia Caso González, María José Nebot Villacampa, Ricardo Zafra Morales, Yared González Pérez, María Teresa Barajas Santos
Introduction: Direct oral anticoagulants (DOAC) or non-vitamin K antagonist oral anticoagulants (NOAC) are an effective alternative for the treatment of non-valvular atrial fibrillation. The elderly have pathophysiological characteristics that make it necessary to adjust the medication to their baseline state. NOAC have dosing and control advantages over antivitamins K, but dose adjustment is necessary based on renal clearance, age and weight, as stated in the data sheet of direct oral anticoagulants. The objective of the study is to evaluate the dose adjustment of these drugs (dabigatran, rivaroxaban, apixaban, edoxaban) in elderly patients institutionalized in social health centers (SHC) according to kidney function, weight and age so that it does not pose a problem of efficacy and safety, regarding underdosing and overdosing and establish dose recommendations to responsible physicians.
Method: A prospective observational and descriptive study was carried out during the month of March 2019. The study population was selected from elderly residents from the 11 social health centers, in Logroño (La Rioja). The inclusion criterion was the prescription of a VKA or NOAC at the time of the review. The data for the dose adjustment of the NOAC were obtained from the positioning report «Therapeutic Positioning Report UT NOACS/V5/21112016» of November 21, 2016 on «General criteria and recommendations for the use of DOAC in the prevention of stroke and systemic embolism in patients with VADF» and from the data sheet of each drug.
Results: Of 1,587 SHC residents, 238 (15%) were on oral anticoagulant therapy 15, 18.5% of the patients had NOAC, mostly rivaroxaban. The 9.1% of patients with NOAC were overdosed and 27.27% underdosed. An intervention was to notify the physicians responsible for four patients in charge to avoid the risk of bleeding due to overdosing, two of them being accepted by the physician and adjusting the dose of NACO.
