Study on the efficacy and influencing factors of Dabigatran in elderly patients / 中华老年医学杂志

ABSTRACT

Objective:To observe the efficacy of Dabigatran etexilate anticoagulation therapy and analyze its influencing factors in elderly patients.Methods:The clinical data of the elderly patients using Dabigatran etexilate anticoagulation for prevention or treatment of thrombosis in the Department of Geriatrics, Peking University First Hospital were collected.Changes of coagulation indexes and its influencing factors were analyzed when taking Dabigatran in different doses.Results:A total of 142 patients receiving Dabigatran therapy were collected, with an average age of(79.0±7.5)years.Among them, 128 patients had atrial fibrillation and 14 had deep venous thrombosis and/or pulmonary embolism.After taking Dabigatran, the trough values of activated partial thromboplastin time(APTT)and thrombin time(TT)were increased significantly in all patients compared with that before administration( P<0.001). In patients taking Dabigatran 110 mg once a day, APTT was(32.4±3.0)s before administration, with a trough value of(41.4±5.4)s and a peak value of(53.9±9.8)s.In patients taking Dabigatran 110 mg twice a day, APTT was(31.0±3.1)s before administration, with a trough value of(42.4±5.5)s and a peak value of(48.7±7.3)s.Compared with patients taking Dabigatran 220 mg/d, those who took Dabigatran 110 mg/d were older( P<0.0001), often women( P<0.0001), had lower body weight( P=0.001), body mass index( P=0.018)and creatinine clearance rate( P<0.001), and higher basal( P=0.008)and peak values( P=0.002)of APTT, but with similar trough values.Multivariate analysis showed that the APTT trough values were significantly related with APTT basal value( β=0.885, P<0.001), creatinine clearance rate( β=-0.121, P<0.001), dosage of Dabigatran( β=0.037, P<0.001)and combined amiodarone( β=3.784, P=0.022). Conclusions:There are individual differences in the anticoagulant effect of Dabigatran etexilate.The APTT trough value is higher in patients with high APTT basal value, high Dabigatran dose, low creatinine clearance rate and combined use of amiodarone.Dabigatran 110 mg/d was often used in women, elderly patients, and those with low body weight, and decreased renal function, and with a similar trough value and a high peak value of APTT compared with patients on Dabigatran 220 mg/d.