Key result
Dose-normalised dabigatran trough concentrations were significantly higher in very elderly patients (≥85 years) compared to younger patients (<75 years) (1.20 vs 0.66 ng/mL/mg; p=0.004).
Why the study?
Patients older than 75 years on dabigatran face a higher risk of gastrointestinal bleeding than those on warfarin, and high trough concentrations significantly impact this risk.
Do dabigatran trough concentrations differ across age groups in patients with atrial fibrillation?
Observational (n=75)
Do dabigatran trough concentrations differ across age groups in patients with atrial fibrillation?
Absolute Event Rate: 1.2% vs 0.66%
p-value: p=0.004
Very elderly patients (≥85 years) have significantly higher dose-normalized dabigatran trough concentrations, highlighting the need for careful dosing and monitoring in this population.
May warrant dose caution with dabigatran in very elderly AF patients; leaves open value of trough-guided monitoring.
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.
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Gommans et al. (2020) conducted an observational in Atrial fibrillation (n=75). Dabigatran vs. Younger age groups (<75 years) was evaluated on Dose-normalised dabigatran trough concentrations (ng/mL/mg) (p=0.004). Dose-normalised dabigatran trough concentrations were significantly higher in very elderly patients (≥85 years) compared to younger patients (<75 years) (1.20 vs 0.66 ng/mL/mg; p=0.004).
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