Study supports use of reduced-dose of direct oral anticoagulants for many older adults with two or more chronic medical conditions

A nationwide study of 21,878 older nursing home residents with nonvalvular atrial fibrillation (NVAF) found a higher rate of bleeding and little difference in the effectiveness of standard versus reduced-dose treatment using direct oral anticoagulants (DOAC).

“Given the potential harms and unclear benefits of standard DOAC dosing, our results support the use of reduced-dose DOACs for many older adults with multiple chronic medical conditions,” said Dr. Sarah Berry, MD, MPH, of Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research. 

DOACs can prevent serious thrombotic events like stroke in residents with nonvalvular atrial fibrillation (NVAF) and have a lower risk of major bleeding events than warfarin.

Persons receiving standard-dosing of DOACs experienced 1.4 more major bleeds per 100 person-years than those on reduce-dosing, with highest relative bleeding rates among those aged ≥80 years or who were not obese.

Over the 1-year follow-up period, the overall rate of major bleeds in this population was 8.6 per 100 person-years (PY) and 5.7 per 100 PY for thrombotic events.

The findings were reported in the article, Benefits and Harms of Standard versus Reduced-Dose Direct Oral Anticoagulant Therapy for Multimorbid Older Adults with Atrial Fibrillation, published in the Journal of the American Heart Association.

Authors were:

Kaleen N. Hayes, PharmD, PhD, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, and Graduate Department of Pharmaceutical Sciences, University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, ON;

Tingting Zhang, MD, PhD, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI;

Dae Hyun Kim, MD, MPH, ScD, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, MA, Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA;

Lori A. Daiello, PharmD, ScM, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, and Department of Neurology, Warren Alpert Medical School of Brown University, and Alzheimer's Disease and Memory Disorders Center At Rhode Island Hospital, Providence, RI;

Yoojin Lee, MS, MPH, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI;

Douglas P. Kiel, Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and Harvard Medical School, Boston, MA;

Sarah D. Berry*, MD, MPH; Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and Harvard Medical School, Boston, MA;

Andrew R. Zullo,* PharmD PhD, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, and Department of Epidemiology, Brown University School of Public Health, Providence, RI, and Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI.

*Drs. Zullo and Berry contributed equally.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $85 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.