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Frailty as a Marker for the Plasma Concentrations of Direct Oral Anticoagulants in Older Patients: Results of an Exploratory Study
- Background: Frailty makes older adults vulnerable to adverse health outcomes and can modify pharmacokinetics and drug exposure. Objective: We aimed to explore the relationship between different frailty assessments and trough plasma concentrations of direct oral anticoagulants in older patients. Methods: The frailty status of adults aged ≥ 70 years receiving regular direct oral anticoagulant medication was assessed by four different instruments: Fried physical phenotype, Rockwood frailty index, Short Physical Performance Battery, and FRAIL scale. The two performance measures “slow gait speed” and “weak grip strength” were used to build a separate score depending on the number of positive criteria (none, one, two). For each participant, a single steady-state direct oral anticoagulant trough plasma concentration was collected, dose-normalized, and its relationship to the various frailty assessments analyzed. Results: Forty-two participants completed the study, with most using apixaban (n = 22). Dose-normalized apixabanBackground: Frailty makes older adults vulnerable to adverse health outcomes and can modify pharmacokinetics and drug exposure. Objective: We aimed to explore the relationship between different frailty assessments and trough plasma concentrations of direct oral anticoagulants in older patients. Methods: The frailty status of adults aged ≥ 70 years receiving regular direct oral anticoagulant medication was assessed by four different instruments: Fried physical phenotype, Rockwood frailty index, Short Physical Performance Battery, and FRAIL scale. The two performance measures “slow gait speed” and “weak grip strength” were used to build a separate score depending on the number of positive criteria (none, one, two). For each participant, a single steady-state direct oral anticoagulant trough plasma concentration was collected, dose-normalized, and its relationship to the various frailty assessments analyzed. Results: Forty-two participants completed the study, with most using apixaban (n = 22). Dose-normalized apixaban trough concentrations were 2.48-fold higher in frail participants (Fried phenotype) than in robust participants (p = 0.009) and correlated positively with Fried physical phenotype (rs = 0.535, p = 0.010) and negatively with Short Physical Performance Battery (rs = − 0.434, p = 0.044). Compared with participants who met none of the criteria “slow gait speed” and “weak grip strength”, apixaban trough concentrations were approximately 1.9-fold higher in participants who were positive for one (p = 0.018) or two (p = 0.013) of these measures. Conclusions: In this exploratory study, higher levels of frailty on performance-based frailty assessments were associated with higher apixaban exposure in older adults.…
Author: | Annette EidamORCiD, Julian Marji, Petra BenzingerORCiDGND, Kathrin I. Foerster, Jürgen Burhenne, David Czock, Felicitas Stoll, Antje Blank, Gerd Mikus, Walter E. Haefeli, Jürgen M. BauerGND |
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DOI: | https://doi.org/10.1007/s40266-022-00999-y |
Identifier: | 1170-229X OPAC HS OPAC extern |
Identifier: | 1179-1969 OPAC HS OPAC extern |
Parent Title (English): | Drugs & Aging |
Subtitle (English): | evaluations of age-related changes in drug disposition and drug therapy in the elderly |
Publisher: | Springer |
Place of publication: | Berlin |
Document Type: | Article |
Language: | English |
Date of Publication (online): | 2023/01/13 |
Year of first Publication: | 2023 |
Tag: | Antikoagulation; Frailty anticoagulation; frailty |
Volume: | 2023 |
Number of pages: | 12 Seiten |
First Page: | 1 |
Last Page: | 12 |
Institutes: | IGG - Institut für Gesundheit und Generationen |
Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften |
Open Access: | open_access |
Research focus: | FSP4: Soziale Innovationen |
Publication Lists: | Benzinger, Petra |
Publication reviewed: | begutachtet |
Release Date: | 2023/01/19 |