1. Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
- Author
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Leda Marina Pomes, Matilde Capi, Luana Lionetto, Angela Koverech, Paolo Martelletti, Vittoria Polidori, Valeriano Soldati, Maurizio Simmaco, and Andrea Negro
- Subjects
Genetic Markers ,Drug ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,precision medicine ,Population Dynamics ,enzymes ,Administration, Oral ,lcsh:Medicine ,030204 cardiovascular system & hematology ,polytherapy ,Drug Administration Schedule ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Clinical Protocols ,Atrial Fibrillation ,Health care ,medicine ,Humans ,Drug Interactions ,030212 general & internal medicine ,Medical prescription ,Adverse effect ,Intensive care medicine ,Aged ,media_common ,Aged, 80 and over ,Polymorphism, Genetic ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,Anticoagulants ,Multimorbidity ,Atrial fibrillation ,Precision medicine ,medicine.disease ,multimorbid patients ,ageing ,Personalized medicine ,Drug Monitoring ,business ,polymorphisms ,public health, environmental and occupational health ,health, toxicology and mutagenesis - Abstract
The ageing of the world population has resulted in an increase in the number of older patients with multimorbid conditions receiving multiple therapies. This emerging clinical scenario poses new challenges, which are mostly related to the increased incidence of adverse effects. This translates into poor clinical care, reduced cost-effectiveness of drug therapies, and social isolation of multimorbid patients due to reduced autonomy. A strategy to address these emerging challenges could involve the personalization of therapies based on the clinical, molecular, and genetic characterization of multimorbid patients. Anticoagulation therapy is a feasible model to implement personalized medicine since it generally involves older multimorbid patients receiving multiple drugs. In this study, in patients with atrial fibrillation, the use of the new generation of anticoagulation therapy, i.e., direct oral anti-coagulants (DOACs), is based on a preliminary assessment of the molecular targets of DOACS and any possible drug&ndash, drug interactions. Then, the genetic polymorphism of enzymes metabolizing DOACs is studied. After DOAC prescription, its circulating levels are measured. Clinical data are being collected to assess whether this personalized approach improves the safety and efficacy profiles of anticoagulation therapy using DOACs, thereby reducing the costs of healthcare for ageing multimorbid patients.
- Published
- 2018