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Review
. 2025 Jun 20;14(13):4396.
doi: 10.3390/jcm14134396.

The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population-How to Overcome the Challenges of Geriatric Syndromes

Minerva Codruta Badescu  1   2 , Diana Popescu  1   2 , Evelina Maria Gosav  1   2 , Alexandru Dan Costache  1   3 , Diana Elena Cosău  1   3 , Adriana Chetran  1   4 , Ștefania-Teodora Duca  1   4 , Sandu Cucută  1   4 , Ionela Lăcrămioara Șerban  1 , Irina Iuliana Costache Enache  1   4 , Ciprian Rezus  1   2
Affiliations
Review

The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population-How to Overcome the Challenges of Geriatric Syndromes

Minerva Codruta Badescu et al. J Clin Med. .

Abstract

Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with a large number of geriatric patients requiring oral anticoagulant treatment. Our review highlights some of the particularities of using direct oral anticoagulants (DOACs) in the geriatric population. We focused on the difficulties of managing DOAC treatment in the presence of geriatric syndromes. We highlighted the practical steps needed to overcome the challenges related to the risk of falling, cognitive impairment, swallowing disorders, and polypragmasy to improve patient care. We provided data to help guide the choice of anticoagulant and dose.

Keywords: delayed DOAC intake; direct oral anticoagulants; geriatric syndromes; polypragmasy; risk of falling; swallowing disorders.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Correct administration of DOAC (DOAC bid and DOAC od). Treatment administration options in case of delay (A = apixaban, D = dabigatran, E = edoxaban, R = rivaroxaban, od = once a day, bid = twice a day). Green = Yes; Red = No.
Figure 2
Figure 2
DOAC administration in relation to food and swallowing disorders.
Figure 3
Figure 3
Choice of anticoagulant in elderly and frail patients with AF. (* based on the results of the ELDERCARE AF trial).
Figure 4
Figure 4
Choice of anticoagulant in elderly and frail patients with acute VTE.
See this image and copyright information in PMC

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