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More Smart Use of Direct Oral Anticoagulants in Geriatric Patients [Letter]
Received 24 August 2023
Accepted for publication 29 August 2023
Published 6 September 2023 Volume 2023:17 Pages 2747—2748
DOI https://doi.org/10.2147/DDDT.S436943
Checked for plagiarism Yes
Editor who approved publication: Dr Jianbo Sun
Ling-Ling Zhu,1 Quan Zhou2
1Geriatric VIP Ward, Division of Nursing, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, People’s Republic of China; 2Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, People’s Republic of China
Correspondence: Quan Zhou, Department of Pharmacy, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310009, People’s Republic of China, Tel +86-571-8778-4615, Email [email protected]
View the original paper by Miss Kim and colleagues
Dear editor
We read with great interest the study by Kim et al,1 which shows the impact of ABCG2 gene polymorphisms on bleeding complications in apixaban and rivaroxaban users. We especially appreciate the viewpoint that genotyping could provide patients with effective and safe anticoagulation therapy. However, we found one point worthy of discussion and we would like to share our perspectives in the following paragraphs.
According to 2019 American Geriatrics Society (AGS) Beers Criteria® for potentially inappropriate medications, rivaroxaban could increase risk of gastrointestinal bleeding compared with warfarin and reported rates with other direct oral anticoagulants (eg, apixaban and edoxaban) when used for long-term treatment of venous thromboembolism (VTE) or atrial fibrillation in adults more than 75 years (quality of evidence: moderate; strength of recommendation: strong).2 Therefore, we have consciously prioritized apixaban and edoxaban over rivaroxaban in clinical practice for patients aged 75 years, but we did not take into account the effects of genetic pharmacology on the safety issues of apixaban. For the 2023 update, the AGS also strongly recommends to avoid for long-term treatment of atrial fibrillation or VTE with rivaroxaban because that rivaroxaban appears to have a higher risk of major bleeding and GI bleeding in older adults than other DOACs, particularly apixaban.3
Kim et al’s study is the first investigation into the effect of ABCG2-related genetic markers on major bleeding or clinically relevant non-major bleeding in patients receiving apixaban and rivaroxaban. Their work is very enlightening and beneficial for the international community. We believe their contribution helps optimize individualized treatment strategies in elderly patients on anticoagulant therapy. Specifically, older adults, whether older than 75 years of age or not, also need to be careful when receiving apixaban, especially those with the ABCG2 rs3114018 A allele carriers (adjusted odds ratio for bleeding=2.188, 95% CI=1.156, 4.142).
Acknowledgment
This letter was supported by the Department of Education of Zhejiang Province (grant number: Y202249568).
Disclosure
The authors report no conflicts of interest in this communication.
References
1. Kim H, Song TJ, Yee J, Kim DH, Park J, Gwak HS. ABCG2 gene polymorphisms may affect the bleeding risk in patients on apixaban and rivaroxaban. Drug Des Devel Ther. 2023;17:2513–2522. doi:10.2147/DDDT.S417096
2. By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–694. doi:10.1111/jgs.15767
3. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052–2081. doi:10.1111/jgs.18372
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