Geriatrics department, APHP Paris Cité University, Lariboisière-Fernand Widal Hospital, Paris, France.
Paris-Cité University, CNRS, Paris, F-75006, CitCoM, France.
Aging Clin Exp Res. 2024 May 22;36(1):113. doi: 10.1007/s40520-024-02768-w.
Polypharmacy is a frequent situation in older adults that increases the risk of drug-drug interactions (DDIs), both pharmacokinetic (PK) and pharmacodynamic (PD). Direct oral anticoagulants (DOACs) are frequently prescribed in older adults, mainly because of the high prevalence of atrial fibrillation (AF). DOACs are subject to cytochrome P450 3A4 (CYP3A4)- and/or P-glycoprotein (P-gp)-mediated PK DDIs and PD DDIs when co-administered with drugs that interfere with platelet function. The aim of our study was to assess the prevalence of DDIs involving DOACs in older adults and the associated risk factors at admission and discharge.
This was a cross-sectional study conducted in an acute geriatric unit between January 1, 2018 and December 31, 2022, including patients over 75 years of age treated with DOACs at admission and/or discharge, for whom a comprehensive collection of co-medications was performed.
From 909 hospitalizations collected, the prevalence of PK DDIs involving DOACs was 16.9% at admission and 20.7% at discharge, and the prevalence of PD DDIs was 20.7% at admission and 20.2% at discharge. Factors associated with DDIs were bleeding history [adjusted odds ratio (ORa) 1.74, 95% confidence interval (CI) 1.13-2.68], number of drugs > 6 (ORa 2.54, 95% CI 1.88-3.46) and reduced dose of DOACs (ORa 0.39, 95% CI 0.28-0.54) at admission and age > 87 years (ORa 0.74, 95% CI 0.55-0.99), number of drugs > 6 (ORa 2.01, 95% CI 1.48-2.72) and reduced dose of DOACs (ORa 0.41, 95% CI 0.30-0.57) at discharge.
This study provides an indication of the prevalence of DDIs as well as the profile of DDIs and patients treated with DOACs.
老年人同时使用多种药物的情况较为常见，这会增加药物-药物相互作用（DDI）的风险，包括药代动力学（PK）和药效学（PD）的相互作用。直接口服抗凝剂（DOACs）常在老年人中使用，主要是因为心房颤动（AF）的高患病率。当 DOACs 与干扰血小板功能的药物联合使用时，它们会受到细胞色素 P450 3A4（CYP3A4）和/或 P-糖蛋白（P-gp）介导的 PK DDI 和 PD DDI 的影响。我们研究的目的是评估老年人中涉及 DOAC 的 DDI 的患病率，以及入院和出院时相关的危险因素。
这是一项横断面研究，于 2018 年 1 月 1 日至 2022 年 12 月 31 日在一个急性老年病房进行，纳入入院和/或出院时接受 DOAC 治疗的年龄在 75 岁以上的患者，对他们进行了全面的合并用药采集。
从收集的 909 例住院患者中，入院时涉及 DOAC 的 PK DDI 的患病率为 16.9%，出院时为 20.7%，PD DDI 的患病率为入院时为 20.7%，出院时为 20.2%。与 DDI 相关的因素包括出血史[调整后的优势比（ORa）1.74，95%置信区间（CI）1.13-2.68]、用药种类>6 种（ORa 2.54，95% CI 1.88-3.46）和 DOAC 剂量减少（ORa 0.39，95% CI 0.28-0.54）入院时以及年龄>87 岁（ORa 0.74，95% CI 0.55-0.99）、用药种类>6 种（ORa 2.01，95% CI 1.48-2.72）和 DOAC 剂量减少（ORa 0.41，95% CI 0.30-0.57）出院时。
本研究提供了涉及 DOAC 的 DDI 的流行率以及与 DDI 相关的患者和治疗方案的信息。
