Pharmacists Play Critical Role in Optimizing Anticoagulation Therapy for Older Adults | APhA 2025
Elizabeth Pogge, PharmD, professor in the College of Pharmacy at Midwestern University, discusses the safety and efficacy of anticoagulation for this population.
The discussion focuses on the critical role of pharmacists in managing direct oral anticoagulants (DOACs) for older adult patients, with a particular emphasis on drug interactions, patient safety, and personalized care. Elizabeth Pogge, PharmD, professor in the College of Pharmacy at Midwestern University, highlights the complexity of anticoagulation therapy, stressing the importance of understanding both pharmacokinetic and pharmacodynamic interactions. DOACs are sensitive to medications that interact with P-glycoprotein and CYP3A4 enzymes, which can either increase bleeding risks or reduce the drug's effectiveness.
Patient-centered care is paramount in anticoagulation management. The "four M's" approach—focusing on what matters most, medications, mentation, and mobility—guides pharmacists in tailoring treatment. Key considerations include preventing stroke, managing potential adverse effects, addressing cost concerns, and ensuring patient compliance. Education plays a crucial role, with pharmacists needing to counsel patients on recognizing serious bleeding signs, understanding when to seek emergency care, and implementing strategies to reduce bleeding risks. Pogge emphasizes that anticoagulation is often underutilized in older adults, presenting a significant opportunity for pharmacists to intervene.
By conducting comprehensive medication reviews, assessing drug interactions, and monitoring therapy, pharmacists can help optimize anticoagulation treatment. Expanding anticoagulation clinics to include DOACs can provide a structured approach to managing these complex medications. Ultimately, the goal is to balance the potential bleeding risks with the therapeutic benefits, ensuring that each patient receives personalized, safe, and effective anticoagulation therapy tailored to their individual needs and health circumstances.
"My take home point for anticoagulation in older adults is that anticoagulation is oftentimes underutilized in our older adult population, and pharmacists can play a big role in making sure patients are assessed," Pogge said. "If they're determined to be appropriate, then [patients] can be assessed for appropriate dosing. [Pharmacists] can help with safety, looking at drug-drug interactions, as well as monitoring and follow-up."
