Drug Interactions Affecting Oral Anticoagulant Use

Mar, Philip L.; Gopinathannair, Rakesh; Gengler, Brooke; Chung, Mina K.; Pérez, A. Matamala; Dukes, Jonathan W.; Ezekowitz, Michael D.; Lakkireddy, Dhanunjaya; Lip, Gregory Y. H.; Miletello, Mike; Noseworthy, Peter A.; Reiffel, James A.; Tisdale, James E.; Olshansky, Brian

doi:10.1161/circep.121.007956

Cited by 24 publications

(21 citation statements)

References 169 publications

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“…Вероятно, следует избегать сочетания апиксабана и ривароксабана с сильным ингибитором CYP3A4 и P-gp, а если комбинация с сильными ингибиторами CYP3A4 неизбежна, можно обсудить возможность снижения дозы апиксабана и ривароксабана на 50% [27]. Эмпирическое снижение стандартных доз ПОАК не рекомендуется при совместном приеме с умеренными ингибиторами CYP3A4 [27].…”

Section: Discussionunclassified

Effect of ABCB1 Gene Carriage and Drug-Drug Interactions on Apixaban and Rivaroxaban Pharmacokinetics and Clinical Outcomes in Patients with Atrial Fibrillation and Deep Vein Thrombosis

Федина

Sychev

Rastvorova

et al. 2023

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To investigate the effect of ABCB1 gene carriage and interdrug interactions on apixaban pharmacokinetics and clinical outcomes in patients with atrial fibrillation and deep vein thrombosis.Material and methods. Patients hospitalized at Yudin State Clinical Hospital participated in the study. A total of 92 patients (50 patients received apixaban and 42 – rivaroxaban) with non-valvular atrial fibrillation and deep vein thrombosis were included. Genotyping was performed by real-time polymerase chain reaction. Direct oral anticoagulants concentrations were measured using an electrospray ionization mass spectrometer in positive ionization mode.Results. In our study we found that in patients carrying the CT+TT ABCB1 (rs4148738) C>T genotype encoding the carrier protein (P-gp), the plasma concentration of rivaroxaban was statistically significantly higher p= 0.026. In addition, we found that patients taking apixaban together with a CYP3A4/P-gp inhibitor were 3.5 times more likely to have hemorrhagic complications than those without inhibitors p = 0.004.Conclusion. Our study revealed that the plasma concentration of rivaroxaban was higher in patients carrying the ABCB1 (rs4148738) C>T polymorphism T allele. And patients taking apixaban together with CYP3A4/P-gp inhibitor had higher risk of hemorrhagic complications in comparison with patients not taking such drugs. Further studies are needed on the influence of pharmacogenetics and pharmacokinetics on the safety and efficacy profile of apixaban and rivaroxaban, taking into account the trend of systemic approach to optimization of anticoagulant therapy of direct oral anticoagulants based on pharmacokinetic, pharmacogenetic biomarkers.

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Section: Discussionunclassified

Effect of ABCB1 Gene Carriage and Drug-Drug Interactions on Apixaban and Rivaroxaban Pharmacokinetics and Clinical Outcomes in Patients with Atrial Fibrillation and Deep Vein Thrombosis

Федина

Sychev

Rastvorova

et al. 2023

Racionalʹnaâ farmakoterapiâ v kardiologii

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“…In these patients, one should consider the drug interactions before starting the management. Metabolism of antifibrotics and anticoagulants is strongly influenced by cytochrome P450 3A4 (CYP3A4) and CYP1A2 [8,9]. Antifungal azoles like itraconazole, and voriconazole which is the treatment of choice in CCPA are inhibitors of CYP3A4, and CYP1A2 which may lead to decreased metabolism of antifibrotics and anticoagulants causing increased side effects [9].…”

Section: Discussionmentioning

confidence: 99%

Aspergilloma in Non-tuberculous Cavities in the Lung: Not to Get Startled

Pavirala¹,

Rao²,

Sahu³

et al. 2022

Cureus

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Aspergillus which is normally found as a colonizer in healthy individuals can manifest in various forms in patients with diseased lung or immunocompromised status. Aspergilloma is one such manifestation whereby the fungus makes its way into preexisting cavities in the lung, the most common underlying etiology being old tuberculous cavities, especially in countries with high TB prevalence. However, we hereby report two cases of Aspergillus infestation as aspergilloma in cavities because of extremely rare causes, namely pulmonary thromboembolism and idiopathic pulmonary fibrosis, respectively.

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“…8, табл.) [26] ■ Сравните степень такого взаимодействия для препаратов с аналогичными показаниями ■ Обсудите возможность замены со специалистом, назначившим эти средства ■ Консультация клинического фармаколога (вопрос о терапевтическом лекарственном мониторинге (рис. 9) [26] ■ Обсудите с пациентом риски совместного приема ПОАК и препаратов, изменяющих их фармакологические эффекты.…”

Section: полипрагмазия что делать?unclassified

Anticoagulant therapy with direct oral anticoagulants in the context of polypragmasy: a course to safety

et al. 2022

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Cardiovascular disease is the most common cause of death in the world. For almost 60 years vitamin K antagonists (VKAs) have been the mainstay of anticoagulant therapy, but in recent years direct oral anticoagulants (DAACs) have become the anticoagulant of choice, as they have many well-known advantages: more predictable anticoagulant effect, no need for dose selection (there is a need for dose adjustment only for renal dysfunction), routine laboratory monitoring of pharmacodynamic effect (except in special clinical situations), less frequency of clinically significant drug interactions compared with warfarin, and less dependence on patient genetic characteristics. The main indications for POAC are: prevention of venous thromboembolism in patients who have undergone endoprosthesis of lower limbs, prevention of stroke and systemic embolism in patients with atrial fibrillation, treatment and prevention of recurrent deep vein thrombosis (DVT) and pulmonary embolism. The administration of direct oral anticoagulants (DOACs) has long been considered a major therapeutic advance, mainly because they do not require therapeutic monitoring. Despite this, POACs, like vitamin K antagonists, can still cause major and clinically significant minor bleeding, even when used correctly. Considering that POAC patients are often older and have multiple comorbidities, polypragmasy is widespread. Drug interactions involving POACs are important contributors to the increased risk of bleeding. Awareness of these drug interactions and how to address them is critical to optimizing treatment while reducing the risk of bleeding. This review provides an overview of POAC metabolism, the most common drugs that may interact with POACs, and ways to eliminate these interactions.

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Drug Interactions Affecting Oral Anticoagulant Use

Cited by 24 publications

References 169 publications

Effect of ABCB1 Gene Carriage and Drug-Drug Interactions on Apixaban and Rivaroxaban Pharmacokinetics and Clinical Outcomes in Patients with Atrial Fibrillation and Deep Vein Thrombosis

Effect of ABCB1 Gene Carriage and Drug-Drug Interactions on Apixaban and Rivaroxaban Pharmacokinetics and Clinical Outcomes in Patients with Atrial Fibrillation and Deep Vein Thrombosis

Aspergilloma in Non-tuberculous Cavities in the Lung: Not to Get Startled

Anticoagulant therapy with direct oral anticoagulants in the context of polypragmasy: a course to safety

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