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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

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Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
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Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
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As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
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Dabigatran trough concentrations in very elderly patients.

Ellis Gommans1,2, René J E Grouls3, Daan Kerkhof4

  • 1Geriatrics, Catharina Hospital, Eindhoven, The Netherlands ellisgommans@gmail.com.

European Journal of Hospital Pharmacy : Science and Practice
|September 26, 2020
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Elderly patients have higher dabigatran concentrations, increasing bleeding risk. Even with dose adjustments, very elderly individuals show elevated levels, necessitating clinical awareness.

Keywords:
anticoagulantsdrug monitoringgeriatricssafetythromboembolism

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Area of Science:

  • Pharmacology
  • Geriatrics

Background:

  • Dabigatran is an anticoagulant used for atrial fibrillation.
  • Elderly patients (>75 years) on dabigatran face a higher risk of gastrointestinal bleeding compared to warfarin.
  • High dabigatran trough concentrations are linked to increased bleeding risk.

Purpose of the Study:

  • To investigate dabigatran concentrations in elderly and very elderly patients within a real-world setting.
  • To assess the impact of age on dabigatran levels in patients with atrial fibrillation.

Main Methods:

  • Observational study involving 75 atrial fibrillation patients.
  • Patients categorized by age: <75, ≥75 to 84, and ≥85 years.
  • Measured dabigatran trough concentrations, both absolute and dose-normalized, excluding those on interacting medications or with severe renal failure.

Main Results:

  • Dabigatran trough concentrations were significantly higher in the oldest age group (≥85 years).
  • Dose-normalized median concentrations were 0.66, 0.83, and 1.20 ng/mL/mg for the <75, ≥75-84, and ≥85 age groups, respectively (p=0.004).

Conclusions:

  • Clinicians must recognize that elderly patients may experience higher dabigatran concentrations.
  • Even with dose reductions, very elderly individuals can have elevated levels, highlighting the need for careful monitoring.