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Assessment of exposure to direct oral anticoagulants in elderly hospitalised patients

Lookup NU author(s): Dr Emma KampourakiORCiD, Dr Peter Avery, Dr Tina Biss, Dr Hilary Wynne, Professor Farhad Kamali


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© 2021 British Society for Haematology and John Wiley & Sons Ltd. It is unclear whether elderly patients established on direct oral anticoagulants (DOACs) have greater exposure to these drugs, which could subsequently increase their risk of bleeding. We assessed DOAC exposure and factors affecting it in a real-world elderly cohort of patients. For this, 151 medically stable hospital inpatients (76 established on apixaban, 61 on rivaroxaban, 14 on dabigatran) with a median [interquartile range (IQR)] age of 84 (78–89) years were recruited. Patients provided blood samples for measurement of peak and trough plasma DOAC concentrations. There was up to 48-fold and 13-fold variation in trough and peak plasma drug concentrations respectively. A significantly greater proportion of patients on apixaban had peak plasma drug concentrations within the reported ranges compared to those on either rivaroxaban or dabigatran (82·9% vs. 44·3% vs. 64·3% respectively; P < 0·001). A third of the variability in DOAC plasma concentrations was attributed to the influences of DOAC dosage, renal function and gender. To what extent the observed increases in DOAC exposure in the older patients is the cause of their increased risk of bleeding, which could potentially be ameliorated by dosing titration, requires further investigation.

Publication metadata

Author(s): Kampouraki E, Avery P, Biss T, Wynne H, Kamali F

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2021

Volume: 195

Issue: 5

Pages: 790-801

Print publication date: 01/12/2021

Online publication date: 17/10/2021

Acceptance date: 30/09/2021

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: John Wiley and Sons Inc.


DOI: 10.1111/bjh.17899


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