PO118 | VARIATION OF EGFR IN PATIENT IN DOACS THERAPY

S. Vivolo, C. Gagliardi, A. Ciampa | U.O.S.D. Centro Emostasi Aorn S. G. Moscati Avellino, Italy

Background and Aims. The introduction of direct oral anticoagulant drugs (DOACs) into clinical practice has represented a revolution in the prevention and treatment of thrombotic events in different clinical settings. Their use is now well established in the prevention of systemic thromboembolism in patients with non-valvular atrial fibrillation (AF) and in the prophylaxis and treatment of venous thromboembolism (VTE). Their application is also expanding in other clinical settings. The factors that have led to such a large diffusion of DOACs lie essentially in their pharmacological characteristics. The more predictable dose-response relationship, the lower interaction with other drugs and with food, and the overcoming of the need to monitor anticoagulant activity represent undoubted advantages over vitamin K antagonists (VKAs). However, the use of DOACs should be evaluated during therapy based on several data, including liver and kidney function. This study focused on the change in renal function during therapy and as age increased.
Methods. We conducted a retrospective observational study on patients enrolled in the Hemostasis Center of the AORN S. Moscati (AV) and receiving therapy with DOACs (dabigatran, rivaroxaban, apixaban and edoxaban). The study court consists of 105 patients aged 21-90 years. The study cohort was divided into four groups: patients aged < 40 years; patients aged 41-60; patients aged 61-75; patients aged >76 years. Patients were periodically evaluated for glomerular filtration rate (eGFR) according to the following schedule: First assessment after six months of treatment. Second assessment after 12 months of treatment. Third assessment after 18 months of treatment. Fourth assessment after 24 months of treatment.
Results. From November 2013 to February 2026, 105 patients (43 males) with DOACs therapy were included in the study. At entry, the mean patient age was 65 +/- 4 years. 38% in edoxaban (4% in low dose), 17% in apixaban (4% in low dose), 2% in dabigatran (150mg), 43% in rivaroxaban (25% in low dose and 8% in medium dose). The eGFR was calculated using the Cockcroft-Gault formula. The reduction in eGFR capacity is indirectly proportional to advancing age. The group with the greatest change in eGFR was patients aged >76 years. Conversely, the group with a miron variation in eGFR was the one aged 41-60 years (Image).
Conclusions. DOACs, due to their pharmacological characteristics and safety profile, have represented an important step forward in anticoagulant therapy. The potential loss of some of their most advantageous properties, such as the predictability of the dose-response relationship, implies that their use must be carefully evaluated especially in patients with an advanced age as these are more critical: they represented the group with the greatest variation in eGFR.