Direct oral anticoagulant therapy and drug interactions in patients with atrial fibrillation
1Merkur University Hospital, Department of Internal Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
2 University Hospital Sveti Duh, Department for Anesthesiology, Reanimatology and Intensive Care, University of Osijek, School of Medicine, Osijek, Croatia
DOI: 10.22514/SV131.032017.11 Vol.13,Issue S1,May 2017 pp.68-70
Published: 08 May 2017
Background. Drug-drug interactions (DDIs) are one potential cause of adverse drug events. Very little has been done to study the relationship between potential DDIs in patients (p) with atrial fibrilla-tion (AF) on direct oral anticoagulants (DOACs). Many anticoagulants are elimi-nated by the kidneys, so they can accumu-late if their dose is not adapted to the kid-ney function. DDI is one particular type of drug error that can result in adverse drug events (ADEs) in exposed patients and was the aim of this study.
Materials and Methods. A total of 50 pa-tients with AF on DOACs (25 patients on dabigatran and 25 on rivaroxaban) with normal, mildly or moderately decreased (estimated GFR > 30 mlmin-11.73m2) renal function were included (age 69±7 years, 26M/24F, body mass index (BMI) 35.4±5.1 kg/m2, duration of hyperten-sion 11±5 years, duration of AF 5±2 years, eGFR 58±23 mlmin-11.73m2 (was calcu-lated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula).
Results. The 12-month administration of DOACs caused a nonsignificant de-crease of eGFR (declined from 58±23 mlmin-11.73m2 to 56±17 mlmin-11.73m2 (p=0.01). All patients have the right dose of DOACs according to eGFR. Patients with AF and DOACs on more than 3 different drugs (20%) such as statins, verapamil and amiodarone were more prone to AE. Conclusion. DDIs are one of the most important problems in every day prac-tice. Coadministration of statins with da-bigatran worsens clinical outcomes and a similar interaction might be seen with ve-rapamil and amiodarone. Patients need to be on the right drug/right dose given the kidney function they have, with special care on DDIs.
drug-drug interactions, direct oral anticoagulants, renal function
INGRID PRKAČIN,VIŠNJA NESEK ADAM,GORDANA CAVRIĆ,TOMO SVAGUŠA,MATEA KOVAČIĆ,IVONA KOVAČEVIĆ. Direct oral anticoagulant therapy and drug interactions in patients with atrial fibrillation. Signa Vitae. 2017. 13(S1);68-70.
1. Walenga JM, Adiguzel C. Drug and dietary interactions of the new and emerging oral anticoagulants. Int J Clin Pract 2010;64:956-67.
2. Granger CB, Armaganijan LV. Newer oral anticoagulants should be used as first-line agents to prevent thromboembolism in patients with atrial fibrillation and risk factors for stroke or thromboembolism. Circulation 2012;125:159–64.
3. Hart RG, Eikelboom JW, Ingram AJ, Herzog CA. Anticoagulants in atrial fibrillation patients with chronic kidney diseases. Nature Reviews Nephrology 2012;8:569-78.
4. Pisters R, Lane DA, Niewulaat R, De Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010;138:1093-100.
5. Glintborg B, Andersen SE, Dalhoff K. Drug-drug interactions among recently hospitalised patients: frequent but mostly clinically insignificant. Eur J Clin Pharmacol 2005;61:675-81.
6. Baillargeon J, Holems HM, Lin YL. Concurrent use of warfarin and antibiotics and the risk of bleeding in older adults. Am J Med 2012;125:183-9.
7. Prkacin I, Cerkez-Habek J. Adverse drug evenst with warfarin in older patients. Thrombosis Research 2014;133:S46.
8. Weitz JI, Pollack CV. Practical management of bleeding in patients receiving non-vitamin K antagonist oral anticoagulants. Thromb Haemost 2015;114:1-14.
9. Pollack CV, Reilly PA, Eikelboom JE, Glund S, Verhamme P, Bernstein RA et al. Idarucizumab for dabigatran reversal. N Engl J Med 2015;373:2413-24.
10. Prkačin I, Cavrić G, Nesek Adam V, Balenović D, Horvat I, Đermanović Dobrota V et al. Oral anticoagulants in patients with chronic kidney disease and atrial fibrillation. Signa Vitae 2016;11:41-3.
11. Qato DM, Jocelyn Wilder J, Schumm LP, Gillet V. Changes in Prescription and Over-the-Counter Medication and Dietary Supple-ment Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016. doi:10.1001/jamainternmed.2015.8581.
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