More precise dosing of acenocoumarol for better control in patients aged above 80 years, a randomised controlled pilot study

M Piersma-Wichers, J H A van Miert*, N J G M Veeger, H A M Kooistra, Karina Meijer

*Corresponding author for this work

Research output: Contribution to journalComment/Letter to the editorAcademicpeer-review

Abstract

INTRODUCTION: Many elderly patients are confined to treatment with vitamin K antagonists (VKA) instead of direct oral anticoagulants (DOACs). However, quality of VKA treatment declines with age. This might be caused by the lower dose requirements with increasing age, which result in relatively large day-by-day VKA dose differences. Therefore, more precise dosing with smaller dose increments might improve quality of VKA treatment in the elderly.

METHODS: We randomised 80 elderly patients (≥80 years, using 0.5-2 mg acenocoumarol daily) to either conventional dosing with 1.0 mg acenocoumarol increments, or more precise dosing with 0.5 mg increments, to assess effect sizes and feasibility of a larger trial. We compared changes in the time in therapeutic range (TTR), INR variability and anticoagulation-related quality of life (measured with the PACT-Q) between treatment groups.

RESULTS: Overall, baseline TTR was 61.3 ± 19.2. After six study months, TTR had improved to 69.5 ± 19.7 in the precise dosing group versus 67.7 ± 21.2 in the conventional dosing group (absolute difference 3.4 (95% CI -6.7 to 13.6)). The between-groups difference in INR variability was not assessed because of baseline differences. PACT-Q convenience declined slightly with more precise dosing, compared with conventional dosing: 2.1/100 (95% CI 0.5-3.7). Satisfaction decreased equally in both groups with -6.4 ± 8.6/100. Four dosing errors occurred: three with precise and one with conventional dosing.

CONCLUSION: Although more precise dosing of acenocoumarol leads to a slightly higher TTR, this effect is too small to convey a relevant clinical benefit and could be abolished by the increased risk of medication errors.

Original languageEnglish
Pages (from-to)536-538
Number of pages3
JournalThrombosis Research
Volume196
Early online date2020
DOIs
Publication statusPublished - Dec-2020

Keywords

  • Anticoagulants
  • Aged 80 and over
  • Coumarins
  • Quality improvement
  • Quality of life
  • NORMALIZED RATIO VARIABILITY
  • VITAMIN-K

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