The Use of Direct Oral Anticoagulants (DOACs) in Older Adults Receiving Multidose Drug Dispensing; Interactions, Anticholinergic and Fall-Risk Increasing Drugs

Key Takeaways for GI Nurses

• Older adults on DOACs receiving multidose drug dispensing are at heightened risk for drug interactions that could affect bleeding risk during endoscopic procedures
• Pre-procedure medication reconciliation must include assessment of anticholinergic medications and fall-risk drugs that may compound DOAC-related bleeding complications
• Patient safety protocols should incorporate screening for polypharmacy interactions, particularly in elderly patients using pill packaging services who may have multiple prescribers
• Enhanced post-procedure monitoring may be warranted for older DOAC patients with complex medication regimens to detect delayed bleeding or cognitive effects

Clinical Relevance

This research highlights a critical patient safety concern for endoscopy units caring for an increasingly aging population. Older adults receiving multidose drug dispensing often have complex medical conditions requiring multiple medications, creating a perfect storm for drug interactions with DOACs. For GI nurses, this means our standard pre-procedure DOAC protocols may be insufficient for elderly patients whose bleeding risk could be modified by concurrent medications. The interaction between DOACs and anticholinergic drugs is particularly concerning, as these medications can affect cognitive function and increase confusion, potentially impacting patient cooperation during procedures and post-procedure care compliance.

From an operational standpoint, this research suggests endoscopy units should implement more comprehensive medication review processes for older DOAC patients. Rather than simply confirming DOAC timing and dosing, nurses need to evaluate the entire medication profile for potential interactions. This may require enhanced collaboration with pharmacists and primary care providers, particularly for patients using pill packaging services who may not fully understand their complete medication regimen. Additionally, the identified connection between DOACs and fall-risk medications has implications for post-procedure mobility assessments and discharge planning, as sedated patients on multiple fall-risk drugs may require modified recovery protocols.

The findings also underscore the importance of patient education tailored to older adults with complex medication regimens. GI nurses must ensure these patients understand not only DOAC management around procedures but also how their other medications might influence recovery. This population may benefit from simplified written instructions and family involvement in discharge teaching to ensure safe medication management at home.

Bottom Line

Older adults on DOACs who receive multidose drug dispensing represent a high-risk population requiring enhanced medication assessment beyond standard anticoagulation protocols. GI nurses must expand their pre-procedure evaluation to identify anticholinergic and fall-risk medications that could compound bleeding risks or complicate recovery, ultimately requiring more comprehensive safety measures and potentially modified post-procedure monitoring to ensure optimal patient outcomes.