A.I. Burnasyan FMBC clinical bulletin. 2023 № 2
I.V. Gribkova1, A.A. Zavialov2
Use of Direct Oral Anticoagulants in Elderly Patients with Cancer
1State Budgetary Institution «Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department», Russia
2A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia
Contact person: Irina Vladimirovna Gribkova: igribkova@yandex.ru
Abstract
Venous thromboembolism is a common complication in elderly patients, especially in the presence of cancer. Currently used for thromboprophylaxis, vitamin K antagonists and low molecular weight heparins are effective, but have a number of disadvantages, which leads to a rare prescription of anticoagulant therapy in elderly patients. Modern studies have shown that direct oral anticoagulants (DOACs) can also be effective and safe in this category of patients, and the convenience of their use increases patient adherence to treatment. However, elderly patients have a number of features that must be considered when prescribing anticoagulant therapy. So, in the presence of renal failure or impaired liver function, it is necessary to consider the possibility of adjusting the prescribed dose. And in connection with the polypharmacy common in old age and the drug interactions associated with it, it is necessary to carefully consider all the drugs taken by the patient for their compatibility and, if necessary, make replacements. This review presents data on the efficacy and safety of DOACs in elderly patients, as well as presents and systematizes various clinical situations when therapy correction or careful monitoring is required.
Keywords: venous thromboembolism, direct oral anticoagulants, thrombosis; bleeding risk, thromboprophylaxis, cancer, elderly age
For citation: Gribkova IV., Zavialov AA. Use of Direct Oral Anticoagulants in Elderly Patients with Cancer A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2023.2:28-33. (In Russian) DOI: 10.33266/2782-6430-2023-2-28-33
REFERENCES
1. Crous-Bou M., Harrington L.B., Kabrhel C. Environmental and Genetic Risk Factors Associated with Venous Thromboembolism. Semin. Thromb. Hemost. 2016;42;8:808-820. doi:10.1055/s-0036-1592333.
2. Blom J.W., Doggen C.J., Osanto S., Rosendaal F.R. Malignancies, Prothrombotic Mutations, and the Risk of Venous Thrombosis. JAMA. 2005;293;6:715-722. doi:10.1001/jama.293.6.715.
3. Alikhan R., Cohen A.T., Combe S., et al. Risk Factors for Venous Thromboembolism in Hospitalized Patients with Acute Medical Illness: Analysis of the MEDENOX Study. Arch. Intern. Med. 2004;164;9:963-968. doi:10.1001/archinte.164.9.963.
4. Bauersachs R.M., Herold J. Oral Anticoagulation in the Elderly and Frail. Hamostaseologie. 2020;40;1:74-83. doi:10.1055/s-0040-1701476.
5. López-Jiménez L., Montero M., González-Fajardo J.A., et al; RIETE Investigators. Venous Thromboembolism in Very Elderly Patients: Findings from a Prospective Registry (RIETE). Haematologica. 2006;91;08:1046–1051.
6. EINSTEIN Investigators, Bauersachs R., Berkowitz S.D., et al. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N. Engl. J. Med. 2010;363;26:2499-2510. doi:10.1056/NEJMoa1007903.
7. Hokusai-VTE Investigators, Büller H.R., Décousus H., et al. Edoxaban Versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. N. Engl. J. Med. 2013;369;15:1406-1415. doi:10.1056/NEJMoa1306638.
8. Verso M., Munoz A., Bauersachs R., et al. Effects of Concomitant Administration of Anticancer Agents and Apixaban or Dalteparin on Recurrence and Bleeding in Patients with Cancer-Associated Venous Thromboembolism. Eur. J. Cancer. 2021;148:371-381. doi:10.1016/j.ejca.2021.02.026.
9. Raskob G.E., Büller H.R., Segers A. Edoxaban for Cancer-Associated Venous Thromboembolism. N. Engl. J. Med. 2018;379;1:95-96. doi:10.1056/NEJMc1806646.
10. Sardar P., Chatterjee S., Chaudhari S., Lip G.Y. New Oral Anticoagulants in Elderly Adults: Evidence from a Meta-Analysis of Randomized Trials. J. Am. Geriatr. Soc. 2014;62;5:857-864. doi:10.1111/jgs.12799.
11. Sharma M., Cornelius V.R., Patel J.P., Davies J.G., Molokhia M. Efficacy and Harms of Direct Oral Anticoagulants in the Elderly for Stroke Prevention in Atrial Fibrillation and Secondary Prevention of Venous Thromboembolism: Systematic Review and Meta-Analysis. Circulation. 2015;132;3:194-204. doi:10.1161/CIRCULATIONAHA.114.013267.
12. Sadlon A.H., Tsakiris D.A. Direct Oral Anticoagulants in the Elderly: Systematic Review and Meta-Analysis of Evidence, Current and Future Directions. Swiss. Med. Wkly. 2016;146:w14356. doi:10.4414/smw.2016.14356.
13. Bai Y., Guo S.D., Deng H., et al. Effectiveness and Safety of Oral Anticoagulants in Older Patients with Atrial Fibrillation: a Systematic Review and Meta-Regression Analysis. Age Ageing. 2018;47;1:9-17. doi:10.1093/ageing/afx103.
14. Patti G., Pecen L., Lucerna M., et al. Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation. Am. J. Med. 2019;132;6:749-757.e5. doi:10.1016/j.amjmed.2018.12.036.
15. Prandoni P., Lensing A.W., Piccioli A., et al. Recurrent Venous Thromboembolism and Bleeding Complications During Anticoagulant Treatment in Patients with Cancer and Venous Thrombosis. Blood. 2002;100;10:3484-3488. doi:10.1182/blood-2002-01-0108.
16. Sato D., Ikeda S., Koga S., et al. Effectiveness and Safety of Oral Direct Factor Xa Inhibitors for the Treatment of Venous Thromboembolism in Patients with Cancer and/or Older Age. Heart. Vessels. 2019;34;4:678-687. doi:10.1007/s00380-018-1283-5.
17. Gribkova I.V., Lipets E.N., Rekhtina I.G., Bernakevich A.I., Ayusheev D.B., Ovsepyan R.A., Ataullakhanov F.I., Sinauridze E.I. The Modification of the Thrombin Generation Test for the Clinical Assessment of Dabigatran Etexilate Efficiency. Scientific Reports. 2016;6:29242. doi:10.1038/srep29242.
18. Липец Е.Н., Атауллаханов Ф.И., Пантелеев М.А. Интегральные лабораторные тесты гемостаза в диагностике гиперкоагуляции и оценке риска тромбоза. Часть I. Патофизиология гиперкоагуляции и тромбоза // Онкогематология. 2015. Т.10, № 3. С. 73-77. DOI: 10.17650/1818-8346-2015-10-3-10-25/. [Lipets E.N., Ataullakhanov F.I., Panteleyev M.A. Integrated Laboratory Coagulation Tests in hypercoagulation Diagnosis and Thrombosis Risk Assessment. Part I. The Pathophysiology of Thrombosis and Hypercoagulation. Onkogematologiya = Oncohematology. 2015;10;3:73-77 (In Russ.)].
Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Concept and design: I.V. Gribkova.
Manuscript preparation: I.V. Gribkova
Final approval of the manuscript: A.A. Zavyalov
Article received: 28.03.2023. Accepted for publication: 22.04.2023