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

Autor: Leda Marina Pomes, Matilde Capi, Luana Lionetto, Angela Koverech, Paolo Martelletti, Vittoria Polidori, Valeriano Soldati, Maurizio Simmaco, Andrea Negro
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Genetic Markers
Drug
medicine.medical_specialty
Health
Toxicology and Mutagenesis
media_common.quotation_subject
precision medicine
Population Dynamics
enzymes
Administration
Oral
lcsh:Medicine
030204 cardiovascular system & hematology
polytherapy
Drug Administration Schedule
Article
03 medical and health sciences
0302 clinical medicine
Pharmacotherapy
Clinical Protocols
Atrial Fibrillation
Health care
medicine
Humans
Drug Interactions
030212 general & internal medicine
Medical prescription
Adverse effect
Intensive care medicine
Aged
media_common
Aged
80 and over
Polymorphism
Genetic
business.industry
lcsh:R
Public Health
Environmental and Occupational Health
Anticoagulants
Multimorbidity
Atrial fibrillation
Precision medicine
medicine.disease
multimorbid patients
ageing
Personalized medicine
Drug Monitoring
business
polymorphisms
public health
environmental and occupational health
health
toxicology and mutagenesis
Zdroj: International Journal of Environmental Research and Public Health, Vol 15, Iss 8, p 1634 (2018)
International Journal of Environmental Research and Public Health
Volume 15
Issue 8
ISSN: 1660-4601
Popis: 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&ndash
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.
Databáze: OpenAIRE
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