When Deprescribing Gets Complicated – A Case Report
Abstract:
Introduction: Quaternary prevention focuses on avoiding harm resulting from unnecessary medical interventions, seeking to reduce iatrogenesis. In this context, deprescribing is an essential clinical practice especially in polymedi cated patients. New anticoagulants (NOACs) have an advantageous safety profile compared to older anticoagulants such as Acenocoumarol.
Case description: An 84-year-old woman with atrial fibrillation came to an appointment with an INR of 3,2. Her anticoagulant dose was adjusted and her pharmacological therapy was reviewed. She was then referred for an im munohemotherapy appointment where Edoxaban was prescribed. Two months later, she returned with changes in liver analysis. During one of her visits to the hospital between exams, she fractured her right humerus, which was immobilized for 3 weeks, requiring PMR later. Finally, it was realized that it was hepatotoxicity due to Edoxaban.
Discussion: This case illustrates a failed quaternary prevention, where an attempt to improve the patient's therapeu tic profile by switching to a NOAC resulted in a serious adverse effect and further interventions. The decision should have better assessed the risk-benefit ratio, since a more careful and individualized assessment is necessary in elderly and polymedicated patients.
