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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.show moreshow less

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Metadaten
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
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
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