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

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...

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Autores principales: Koverech, Angela, Soldati, Valeriano, Polidori, Vittoria, Pomes, Leda Marina, Lionetto, Luana, Capi, Matilde, Negro, Andrea, Simmaco, Maurizio, Martelletti, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122067/
https://www.ncbi.nlm.nih.gov/pubmed/30072608
http://dx.doi.org/10.3390/ijerph15081634
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author Koverech, Angela
Soldati, Valeriano
Polidori, Vittoria
Pomes, Leda Marina
Lionetto, Luana
Capi, Matilde
Negro, Andrea
Simmaco, Maurizio
Martelletti, Paolo
author_facet Koverech, Angela
Soldati, Valeriano
Polidori, Vittoria
Pomes, Leda Marina
Lionetto, Luana
Capi, Matilde
Negro, Andrea
Simmaco, Maurizio
Martelletti, Paolo
author_sort Koverech, Angela
collection PubMed
description 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–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.
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spelling pubmed-61220672018-09-07 Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach Koverech, Angela Soldati, Valeriano Polidori, Vittoria Pomes, Leda Marina Lionetto, Luana Capi, Matilde Negro, Andrea Simmaco, Maurizio Martelletti, Paolo Int J Environ Res Public Health Article 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–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. MDPI 2018-08-02 2018-08 /pmc/articles/PMC6122067/ /pubmed/30072608 http://dx.doi.org/10.3390/ijerph15081634 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Koverech, Angela
Soldati, Valeriano
Polidori, Vittoria
Pomes, Leda Marina
Lionetto, Luana
Capi, Matilde
Negro, Andrea
Simmaco, Maurizio
Martelletti, Paolo
Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
title Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
title_full Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
title_fullStr Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
title_full_unstemmed Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
title_short Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach
title_sort changing the approach to anticoagulant therapy in older patients with multimorbidity using a precision medicine approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122067/
https://www.ncbi.nlm.nih.gov/pubmed/30072608
http://dx.doi.org/10.3390/ijerph15081634
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