Five-Year Trends in Potential Drug Interactions with Direct-Acting Oral Anticoagulants in Patients with Atrial Fibrillation: An Australian-Wide Study

Abstract

Background: Co-prescribing medications that can interact with direct-acting oral anticoagulants (DOACs) may decrease their safety and efficacy. The aim of this study was to examine the co-prescribing of such medications with DOACs using the Australian national general practice dataset, MedicineInsight, over a five-year period. Methods: We performed five sequential cross-sectional analyses in patients with atrial fibrillation (AF) and a recorded DOAC prescription. Patients were defined as having a drug interaction if they had a recorded prescription of an interacting medication while they had had a recorded prescription of DOAC in the previous six months. The sample size for the cross-sectional analyses ranged from 5333 in 2014 to 19,196 in 2018. Results: The proportion of patients who had potential drug interactions with a DOAC decreased from 45.9% (95% confidence interval (CI) 44.6%–47.4%) in 2014 to 39.9% (95% CI 39.2%–40.6%) in 2018, p for trend < 0.001. During this period, the most frequent interacting class of medication recorded as having been prescribed with DOACs was selective serotonin/serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) antidepressants, followed by non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs) and amiodarone. Conclusions: Overall, potential drug interactions with DOACs have decreased slightly over the last five years; however, the rate of possible interaction with SSRIs/SNRIs has remained relatively unchanged and warrants awareness-raising amongst prescribers.

Novel Drug Interaction index and Risk of Mortality in Older Patients With Atrial Fibrillation Receiving Non Vitamin K Oral Anticoagulants (NOEL Drug)

“…The most frequently interacting drugs in these 3 large studies were phenytoin, nonsteroidal antiinflammatory drugs (NSAIDs), diltiazem, amiodarone, rifampicin, and verapamil. [31][32][33] Our research found carbamazepine, phenytoin, rifampicin, and enzalutamide in the severe interaction group (class X), and the most frequent class D interacting agents were diclofenac, dexketoprofen, naproxen, acetylsalicylic acid, clopidogrel, and propafenone in the moderate interaction group. In our study, the clinical relevant interaction was level was 20%, lower than the previous cohort study reported by Bezahbe et al 33 Different drug interaction assessment methods could explain this.…”

Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: A ten‐year follow‐up

“…Details about this dataset can be found elsewhere. [17][18][19][20][21][22][23][24] Patients newly diagnosed with AF from 1 January 2007 to 31 December 2008 ('screening period') and aged 18 years or more were included in this study. Baseline CHA 2 DS 2 -VA scores were calculated by assessing documented comorbidities until 31 December 2008.…”

“…A total of 400 practice sites contributed data for this study. Details about this dataset can be found elsewhere 17‐24 . Patients newly diagnosed with AF from 1 January 2007 to 31 December 2008 (‘screening period’) and aged 18 years or more were included in this study.…”

Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation

“…15 Details about this dataset can be found elsewhere. [15][16][17][18] Patients newly diagnosed with AF in Australian general practices between 1 January 2009 and 25 April 2019 were included in this study. Patients were defined as having a new AF diagnosis based on their first-ever recorded diagnosis date within the study period.…”

“…It includes patient demographics, diagnoses, prescribed medications, pathology test results, observations and reasons for encounters 15 . Details about this dataset can be found elsewhere 15‐18 …”