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Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach

Author

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  • Angela Koverech

    (Department of Clinical and Molecular Medicine, Azienda Ospedaliera Universitaria S. Andrea, via di Grottarossa 1035/1039, 00189 Rome, Italy
    Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Roma, Italy)

  • Valeriano Soldati

    (NESMOS Department, S. Andrea Hospital, University of Rome Sapienza, 00185 Rome, Italy)

  • Vittoria Polidori

    (NESMOS Department, S. Andrea Hospital, University of Rome Sapienza, 00185 Rome, Italy)

  • Leda Marina Pomes

    (Residency Program in Laboratory Medicine, Gabriele d’Annunzio University, 66100 Chieti, Italy)

  • Luana Lionetto

    (Advanced Molecular Diagnostics Unit, IDI-IRCCS, 00168 Rome, Italy)

  • Matilde Capi

    (Laboratory of Clinical Chemistry, Sant’Andrea Hospital, via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Andrea Negro

    (Department of Clinical and Molecular Medicine, Azienda Ospedaliera Universitaria S. Andrea, via di Grottarossa 1035/1039, 00189 Rome, Italy)

  • Maurizio Simmaco

    (NESMOS Department, S. Andrea Hospital, University of Rome Sapienza, 00185 Rome, Italy)

  • Paolo Martelletti

    (Department of Clinical and Molecular Medicine, Azienda Ospedaliera Universitaria S. Andrea, via di Grottarossa 1035/1039, 00189 Rome, Italy)

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–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.

Suggested Citation

  • Angela Koverech & Valeriano Soldati & Vittoria Polidori & Leda Marina Pomes & Luana Lionetto & Matilde Capi & Andrea Negro & Maurizio Simmaco & Paolo Martelletti, 2018. "Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach," IJERPH, MDPI, vol. 15(8), pages 1-8, August.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:8:p:1634-:d:161489
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    References listed on IDEAS

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    1. Richard Sullivan & C. S. Pramesh & Christopher M. Booth, 2017. "Cancer patients need better care, not just more technology," Nature, Nature, vol. 549(7672), pages 325-328, September.
    2. Boris Kauhl & Werner Maier & Jürgen Schweikart & Andrea Keste & Marita Moskwyn, 2018. "Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-18, February.
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