Anticoagulants are one of the most frequently prescribed medications in elderly patients.
Some common cardiovascular disorders in older adults have a relationship to thrombosis, including ischemic heart disease, atrial fibrillation, valvular disease, and atherosclerotic vascular disease.
Thrombophilia (sometimes hyper coagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels). Such abnormalities can be identified in 50% of people who have an episode of thrombosis (such as deep vein thrombosis in the leg) that was not provoked by other causes.
Older adults represent a patient population at high thromboembolic risk, but also at high hemorrhagic risk. Physicians have a tendency to underuse anticoagulants in the elderly, most likely because of underestimation of thromboembolic risk and overestimation of bleeding risk.
Despite the stroke risk being much higher in the elderly population, the presence of associated comorbidities and accompanying polypharmacy leads to physicians’ being less eager to initiate anticoagulation therapy in the elderly, despite the greater absolute stroke risk reduction by doing so.
Another consideration in deciding on anticoagulation therapy is the elderly patients’ propensity to fall. According to the U.S. Centers for Disease Control and Prevention, every 11 seconds an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
One of the most compelling examples of potential benefits from pharmacogenetic testing is warfarin. Warfarin is a widely prescribed oral anticoagulant; for decades it has been used as standard drug to prevent and treat thrombotic events in patients with deep vein thrombosis, various hypercoagulable states, atrial fibrillation, surgical cardiac valve replacement, etc.
One of the major problems with its use in clinical practice is large inter-individual variation – patients differ in sensitivity to warfarin, hence the dose requirements vary widely (up to 20-fold). The consequences of over- or under-anticoagulation can be serious. In patients less sensitive than typical, the standard doses may be too low to achieve anticoagulation and therapeutic failure may occur, while in highly sensitive individuals the same doses may lead to serious adverse effects, such as hemorrhage.
PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics into the field of aging services. We work with LTC communities, clinics and pharmacies across the country educating and implementing pharmacogenetics into their day-to-day patient care.
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source: uptodate.com, ncbi.com, intechopen.com