Reduced Doses of Direct Oral Anticoagulants Safer for Many Nursing Home Residents

Reduced doses of direct oral anticoagulants in older nursing home residents with nonvalvular atrial fibrillation were associated with lower rates of bleeding and similar effectiveness compared with standard doses, according to a study published online in the Journal of the American Heart Association.

“Given the potential harms and unclear benefits of standard direct oral anticoagulant dosing, our results support the use of reduced‐dose direct oral anticoagulants for older adults with multiple morbidities,” wrote corresponding author Sarah Berry, MD, MPH, of the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts, and study coauthors.

The nationwide cohort study included 21,878 nursing home residents with nonvalvular atrial fibrillation. Among participants, the average age was 82 years, and two-thirds were women. Using Medicare and Minimum Data Set records, researchers investigated safety and effectiveness of standard versus reduced doses of direct oral anticoagulant therapy.

Compared with reduced doses, standard doses of direct oral anticoagulant therapy were linked with neither lowered mortality nor reduced thrombotic events, the study found. However, residents who received standard doses had 1.4 more major bleeds per 100 person-years than residents who received reduced doses. The highest relative bleeding rates with standard dosing were in residents 80 or older and in those with a body mass index less than 30 kg/m²

“Taken together, our results suggest that providers may consider the use of reduced‐dose direct oral anticoagulants for many nursing home residents and other frail older adults given the potential lack of benefit for thrombotic events and increased risk of bleeding,” researchers wrote. “However, the results of our study should not be interpreted as encouraging further dose reductions among individuals who are already on doses lower than the current labeling‐recommended regimens.”

References

Hayes KN, Zhang T, Kim DH, et al. Benefits and harms of standard versus reduced-dose direct oral anticoagulant therapy for older adults with multiple morbidities and atrial fibrillation. J Am Heart Assoc. 2023;12(21):e029865. doi:10.1161/JAHA.122.029865

Study supports use of reduced-dose of direct oral anticoagulants for many older adults with two or more chronic medical conditions. News release. Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research; November 7, 2023. Accessed December 12, 2023.