Impact of geriatric assessment on the prescription of direct oral anticoagulants: Cohort study

Prescribing DOACs (Direct Oral Anticoagulants) in the elderly must consider the frailty of this population as well as the multiple associated physiological changes. In this context, Geriatric Assessment (GA) remains an essential tool allowing multidimensional evaluation of their nutritional, cognitive, psychological, and social status. Objective: To assess the impact of GA on the prescription of DOACs in the Internal Medicine and Cardiology departments of HMIMV. Methods: We report an observational, prospective, single-center cohort study conducted on a series of 30 patients on DOACs, who underwent a comprehensive and multidisciplinary assessment through a questionnaire to highlight the impact of GA on DOAC prescription. Results: The average age of our patients was 80 years. All patients presented associated comorbidities: hypertension, dyslipidemia, heart failure, and diabetes. 27% of our patients had a significant risk of falls compared to 30% with moderate risk. Half of our series showed cognitive decline. Polypharmacy was common, with 37% of patients on at least 4 medications. Additionally, 57% of our patients had poor nutritional status. Finally, in terms of renal function evaluation, 15 of our patients had moderate renal insufficiency. Conclusion: Our work highlighted the importance of GA in the management of elderly patients on DOACs. Practically, physicians can optimize the safety and effectiveness of anticoagulant therapy in the elderly while addressing their healthcare needs.