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

Objectives: To examine the prescribing of non-vitamin K-dependent oral anticoagulants (DOACs) among multidose drug dispensing (MDD) users aged ≥65 years, and to describe associated drug–drug interactions (DDIs), concomitant use of fall-risk increasing drugs (FRIDs) and anticholinergic drugs (AC). Methods: Cross-sectional analysis of anonymized MDD medication lists from 87,519 patients in 2018. DDIs were identified using The Norwegian Medical Products Agency interaction tool, FRIDs were defined using the Swedish National Board of Health and Welfare list, and the CRIDECO Anticholinergic Load Scale assessed anticholinergic burden. Results: Among the 13,215 patients aged 65 and older the mean number of prescribed medications was 10.3. At least one DDI involving the prescribed DOACs was present in 26.8% of patients, whereas severe DDIs were rare (0.2%). Almost all (96.7%) used at least one FRID, and nearly half (46.8%) had an anticholinergic score ≥ 3. Conclusions: DOACs are frequently prescribed together with medications that increase the risk of falls and bleeding. These findings highlight the need for individualized risk–benefit evaluations and deprescribing or substituting high impact FRIDS and ACs when clinically appropriate.