Drug interactions with new oral anticoagulants in elderly patients

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care.Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed.Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0–25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients.Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

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Old and new oral anticoagulants: Food, herbal medicines and drug interactions

Blood Reviews ◽

10.1016/j.blre.2017.02.001 ◽

2017 ◽

Vol 31 (4) ◽

pp. 193-203 ◽

Cited By ~ 70

Author(s):

Alessandro Di Minno ◽

Beatrice Frigerio ◽

Gaia Spadarella ◽

Alessio Ravani ◽

Daniela Sansaro ◽

...

Keyword(s):

Drug Interactions ◽

Oral Anticoagulants ◽

Herbal Medicines ◽

New Oral Anticoagulants

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Treatment with new oral anticoagulants in the family medicine practice

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2015.4.4 ◽

2015 ◽

Vol 10 (4) ◽

pp. 329-332

Author(s):

Camelia DIACONU ◽

◽

Giorgiana DEDIU ◽

Mădălina ILIE ◽

Mihaela Adela IANCU ◽

...

Keyword(s):

Drug Interactions ◽

Vitamin K ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Rapid Onset ◽

New Oral Anticoagulants ◽

Anticoagulant Treatment ◽

Oral Anticoagulant Treatment ◽

Rapid Clearance ◽

Concomitant Medications

Vitamin K antagonists represented for more than 50 years the only oral anticoagulant treatment option, though encumbered by numerous food and drug interactions, with direct impact on the safety and efficacy of this treatment. The frequent complications of anticoagulant treatment with vitamin K antagonists led to the need for the emergence of new oral anticoagulants (NOAC). The main NOACs used today are dabigatran, rivaroxaban and apixaban. NOAC have a number of advantages over antivitamin K anticoagulants: fewer drug interactions, no food interactions, rapid onset of the anticoagulant action, rapid clearance, no need for INR monitoring. NOAC therapy must be individualized according to patient age, comorbidities and medical history, renal function, concomitant medications. Given that clinical experience with NOAC is still limited in practice, physicians (including family physicians) must monitor these patients and need to pay attention and report any side effects.

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