PB0001 - The DOAC-FRAIL study; Evaluation of DOAC-levels in acutely admitted frail older patients: an exploratory study.

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Melanie J. de Jong, Msc

Physician Assistant
TEC, MUMC+
Maastricht, Limburg, Netherlands

Co-Author(s)

HS

Hamza Saadan

Physician Assistant
MUMC+
Maastricht, Limburg, Netherlands
Hugo ten Cate, MD, PHD

MD, PhD
Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
Yvonne Henskens

Professor of the department of clinical chemistry
MUMC+
maastricht, Limburg, Netherlands
FM

Fabienne Magdelijns

Head of the section of geriatric medicine
MUMC+
Maastricht, Limburg, Netherlands
RB

Renee Bruggemann

MD, internal medicine, section geriatric medicine
MUMC+
Maastricht, Limburg, Netherlands
DH

Dave Hellenbrand

Laboratory specialist
MUMC+
Maastricht, Limburg, Netherlands
BS

Bart Spaetgens

MD, internal medicine, section geriatric medicine
MUMC+
Maastricht, Limburg, Netherlands
SV

Sander Van Kuijk

Clinical epidemiologist
MUMC+
Maastricht, Limburg, Netherlands
KW

Kristien Winckers

MD, internal medicine, section vascular medicine
MUMC+
Maastricht, Limburg, Netherlands

Background: The use of DOACs among frail older patients has increased due to the aging population. However, there are no recommendations available regarding DOAC treatment in this population. Additionally, data on DOAC use and management during acute illness is lacking. The study seeks to address these knowledge gaps.

Aims: This exploratory study aims to evaluate DOAC levels in frail older patients acutely admitted to the hospital.

Methods: This prospective exploratory cohort study included acutely admitted patients aged 65 years or older and using a DOAC. DOAC levels were measured after admission.

Results: Of the 42 patients included atrial fibrillation was the indication for DOAC use in 90.5%. Apixaban was prescribed most often (52.4%) with an adequate dose regimen (95.2%). 54.8% of all DOAC levels were outside the on-therapy range with 40.5% above and 14.3% below (figure 1). Patients admitted because of an infection had lower odds of having a DOAC level above the on-therapy range (p 0.003). Impaired renal function < 30ml/min/1.73m2 , a low BMI ( < 20), and rivaroxaban use had higher odds of having a DOAC level above the on-therapy range. Patients using a PPI had lower odds of having a DOAC level below the on-therapy range (p 0.03) (table 1).

Conclusion(s): This study is the first to assess DOAC levels in frail older patients during acute hospitalization. The findings indicate that over half of the DOAC levels were outside the recommended on-therapy range. This highlights the significance of gaining understanding of DOAC management in this population. Future research should investigate reasons behind deviated DOAC levels and implications. The ultimate goal is to establish guidelines for DOAC management in frail older patients.