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Dabigatran trough concentrations in very elderly patients
  1. Ellis Gommans1,2,
  2. René J E Grouls3,
  3. Daan Kerkhof4,
  4. Saskia Houterman5,
  5. Tim Simmers6,
  6. Carolien Van der Linden1
  1. 1Geriatrics, Catharina Hospital, Eindhoven, The Netherlands
  2. 2Geriatrics, St Anna Hospital, Geldrop, The Netherlands
  3. 3Clinical Pharmacy, Catharina Hospital, Eindhoven, The Netherlands
  4. 4Clinical Biochemistry, Catharina Hospital, Eindhoven, The Netherlands
  5. 5Education and Research, Catharina Hospital, Eindhoven, The Netherlands
  6. 6Cardiology, Catharina Hospital, Eindhoven, The Netherlands
  1. Correspondence to Ellis Gommans, Geriatrics, St Anna Hospital, Geldrop, The Netherlands; ellisgommans{at}gmail.com

Abstract

Objectives The aim of this observational study was to explore dabigatran concentrations in elderly and very elderly patients in a real-life population. Patients aged >75 years receiving dabigatran have a significantly higher risk of gastrointestinal bleeding compared withthose receiving warfarin. High trough concentrations have an important impact on this bleeding risk.

Methods We measured dabigatran trough concentrations in 75 patients with atrial fibrillation, divided into age categories <75, ≥75 to 84 and ≥85 years. The most important exclusion criteria were use of interacting medication and severe renal failure. We analysed absolute trough concentrations and concentrations normalised for dose.

Results Trough concentrations were considerably higher in the highest age category. Dose-normalised medians were 0.66, 0.83 and 1.20 ng/mL/mg in the <75, ≥75–84 and ≥85 age groups, respectively (p=0.004).

Conclusion Clinicians should be aware of higher dabigatran concentrations in elderly patients despite dose reduction.

  • anticoagulants
  • drug monitoring
  • geriatrics
  • safety
  • thromboembolism

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