{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:11:42Z","timestamp":1787015502212,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Direct oral anticoagulants (DOACs) are prescribed using fixed dosing regimens, despite limited evidence on their pharmacokinetic behavior in nursing home residents.<\/jats:p>\n <\/jats:sec>\n \n Participants and Setting<\/jats:title>\n One hundred nursing home residents are receiving apixaban, rivaroxaban, dabigatran, or edoxaban in multiple long\u2010term care facilities in the Netherlands.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this prospective observational study, DOAC peak levels were measured 2\u20134\u2009h post\u2010dose during routine laboratory testing. Levels were classified as below, within, or above the expected on\u2010therapy range. Logistic regression analyses identified factors associated with peak levels outside the expected on\u2010therapy range.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall, 40% of residents had DOAC peak levels outside the expected on\u2010therapy range; 32% were above and 8% were below. In univariable analyses, above\u2010range levels were associated with lower renal function, apixaban use, and history of myocardial infarction, but none remained independently associated after multivariable adjustment. Below\u2010range levels were associated with preserved renal function and rivaroxaban use; analyses for below\u2010range levels were limited to univariable analyses due to the small number of events.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A substantial proportion of nursing home residents exhibited DOAC peak levels outside the expected on\u2010therapy range despite guideline\u2010concordant dosing. These findings highlight the complexity of anticoagulant management in frail older adults residing in long\u2010term care and support the need for careful clinical reassessment of DOAC therapy in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.70559","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:57:57Z","timestamp":1783061877000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The\n DOAC<\/scp>\n \u2010\n FRAIL<\/scp>\n Study\u2014Same Dose, Different Story: Prevalence of Deviant Direct Oral Anticoagulant Levels in Nursing Home Residents"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9363-0877","authenticated-orcid":false,"given":"Irme S.","family":"Franssen","sequence":"first","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht University Medical Center+ Maastricht the Netherlands"},{"name":"Departments of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2799-2491","authenticated-orcid":false,"given":"Melanie J.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht University Medical Center+ Maastricht the Netherlands"},{"name":"Departments of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Visseren","sequence":"additional","affiliation":[{"name":"Envida Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6744-8911","authenticated-orcid":false,"given":"Daan","family":"Teerds","sequence":"additional","affiliation":[{"name":"Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Hellenbrand","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, Department of Clinical Chemistry and Hematology Maastricht University Medical Center Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Henskens","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, Department of Clinical Chemistry and Hematology Maastricht University Medical Center Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri","family":"Spronk","sequence":"additional","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht University Medical Center+ Maastricht the Netherlands"},{"name":"Departments of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy J. A.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences Maastricht University Maastricht the Netherlands"},{"name":"Department of Expertise and Treatment Proteion Horn the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne C. W.","family":"Braeken","sequence":"additional","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht University Medical Center+ Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander M. J.","family":"van Kuijk","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Center+ Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristien","family":"Winckers","sequence":"additional","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht University Medical Center+ Maastricht the Netherlands"},{"name":"Departments of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Maastricht the Netherlands"},{"name":"Division of General Medicine, Department of Internal Medicine, Section of Vascular Medicine Maastricht University Medical Center+ Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne J. 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