Les AOD : quels sont les facteurs de risque influençant les concentrations plasmatiques ?

Abstract

Since their introduction on the market, direct oral anticoagulants (DOACs) have not ceased to cause Interest of the scientific community. This new class was at least as effective than the reference treatments (AVK and LMWH), and it presents a certain number Advantages over VKAs. The objective of this work was to highlight the risk factors for increased plasma concentration of DOAC, in order to be able to identify patients early likely to benefit most from dosage adjustment or from changing the type of DOA. Our study was spread over a period of 14 months and concerned patients on DOA (mainly rivaroxaban (82.41%) and apixaban), in whom a routine hemostasis assessment (TP, TCA), a NFS, a renal and hepatic assessment were carried out, as well as an indirect assay drugs that inhibit factor Xa by measuring anti-Xa activity by method chromogenic. Our population of 108 patients has an average age of 68.35±15.72, a female predominance (67.59%), an average weight of 74.23 ± 15.42 kg with an average BMI of 28±5.78 and an average GFR of 74.06±35.73ml/min/m². Our results revealed that renal function (GFR) is the major factor influencing concentrations (ρ=0.04). Female gender and advanced age (≥75 years) are also factors that revealed significant differences (ρ=0.01, ρ=0.015) for sex and age respectively). In addition, it has been noted that the concentrations also increase in insufficient overweight (weight<50kg) and obese (BMI>30) but not significantly. Hypertension, diabetes and the association with amiodarone, statins and the dosage induces a increase in anti-Xa concentrations but not significantly. To conclude, this study showed an influence of certain factors on the concentrations plasma levels of DOACs, but further research to bring further benefit information on a larger population is recommended.