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

Angela Koverech, Valeriano Soldati, Vittoria Polidori, Leda Marina Pomes, Luana Lionetto, Matilde Capi, Andrea Negro, Maurizio Simmaco and Paolo Martelletti
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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
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

IJERPH, 2018, vol. 15, issue 8, 1-8

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.

Keywords: ageing; multimorbid patients; polytherapy; precision medicine; enzymes; polymorphisms (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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