Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

Carli, G; Farsi, Alessandro; Chiarini, Francesca; Lippolis, D; Cortellini, Gabriele

doi:10.23822/eurannaci.1764-1489.80

Cited by 20 publications

(20 citation statements)

References 22 publications

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“…Researchers reported a similar finding of switching patients that experienced hypersensitivity reactions with DOACs to VKAs and LMWH. 14 The FAERS case series also highlights the ability to switch to other DOACs after experiencing CSVV. They reported a similar finding in which patients who developed a reaction to rivaroxaban tolerated other DOACs and vice versa.…”

Section: Discussionmentioning

confidence: 99%

Complementary Use of U.S. FDA’s Adverse Event Reporting System and Sentinel System to Characterize Direct Oral Anticoagulants‐Associated Cutaneous Small Vessel Vasculitis

Mohamoud

Horgan²,

Eworuke

et al. 2020

Pharmacotherapy

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BACKGROUND Cutaneous small vessel vasculitis (CSVV) has been reported after exposure to direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban. OBJECTIVE We used the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) to describe clinical characteristics associated with CSVV among DOAC-exposed patients. Furthermore, we characterized this signal in the Sentinel System to relate the clinical data from the individual FAERS cases to population-based electronic healthcare data. METHODS We queried FAERS for all cases of CSVV associated with DOACs from U.S. approval date of each DOAC through March 16, 2018. Within the Sentinel System, we identified incident CSVV cases using ICD-9 and ICD-10 diagnosis codes among adults aged ≥ 30 years who received a DOAC in the prior 90 days between January 1, 2010, and June 30, 2018. We excluded patients with evidence of select autoimmune diagnoses in the 183 days prior to their CSVV diagnoses and reported patient characteristics in the 183-day period prior to CSVV diagnoses. RESULTS In FAERS, we identified 50 cases of CSVV reported with rivaroxaban (n=26), apixaban (n=14), dabigatran (n=9), and edoxaban (n=1). Approximately 50% of the cases reported time to onset within 10 days after DOAC exposure. When specified, the predominant type of CSVV

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Section: Discussionmentioning

confidence: 99%

Complementary Use of U.S. FDA’s Adverse Event Reporting System and Sentinel System to Characterize Direct Oral Anticoagulants‐Associated Cutaneous Small Vessel Vasculitis

Mohamoud

Horgan²,

Eworuke

et al. 2020

Pharmacotherapy

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“…Leukocytoclastic vasculitis hypersensitivity reactions have been reported in association with all DOACs and could confound the assessment of vasculitis activity. 94 This rare DOAC complication should not necessarily represent a contraindication. Optimal anticoagulant duration is unknown, although it is reasonable to postulate that VTE risk may be lower when vasculitis is quiescent.…”

Section: Diabetic Nephropathymentioning

confidence: 99%

Role of direct oral anticoagulants in patients with kidney disease

Derebail

Rheault

Kerlin

2020

Kidney International

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The anticoagulation field is experiencing a renaissance that began with regulatory approval of the direct thrombin inhibitor dabigatran, a direct oral anticoagulant (DOAC), in 2010. The DOAC medication class has rapidly evolved to include the additional approval of 4 direct factor Xa inhibitors. Commensurately, DOAC use has increased and collectively account for the majority of new anticoagulant prescriptions. Despite exclusion of patients with moderateto-severe kidney disease from most pivotal DOAC trials, DOACs are increasingly used in this setting. An advantage of DOACs is similar or improved antithrombotic efficacy with less bleeding risk when compared with traditional agents. Several post hoc analyses, retrospective studies, claims data studies, and meta-analyses suggest that these benefits extend to patients with kidney disease. However, the lack of randomized controlled trial data in specific kidney disease settings, with their unique pathophysiology, should be a call to action for the kidney community to systematically study these agents, especially because early data suggest that DOACs may pose less risk of anticoagulant-related nephropathy than do vitamin K antagonists. Most DOACs are renally cleared and are significantly protein bound in circulation; thus, the pharmacokinetics of these drugs are influenced by reduced renal function and proteinuria. DOACs are susceptible to altered metabolism by P-glycoprotein inhibitors and inducers, including drugs commonly used for the management of kidney disease comorbidities. We summarize the currently available literature on DOAC use in kidney disease and illustrate knowledge gaps that represent important opportunities for prospective investigation.

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“…Makulopapulinė egzantema dažniausiai pasireiškia nutukusioms moterims, per 7-10 dienų nuo heparino vartojimo pradžios [17]. DRESS aprašyta vos keletas atvejų vartojant heparinus, rivaroksabaną [18]. Citotoksinių T limfocitų sukeltas keratinocitų žuvimas IVc reakcijos metu sąlygoja fiksuoto vaistų išbėrimo, Stevens-Džonsono sindromo, toksinės epidermio nekrolizės atsiradimą.…”

Section: Pulmonologija Ir Alergologijaunclassified

“…Šios reakcijos yra retos, tačiau labai pavojingos. Literatūroje aprašyti keli atvejai vartojant heparinus, rivaroksabaną, dabigatraną [18]. IVd reakcijos metu T limfocitai skatina neutrofilų sukeltą uždegimą, todėl gali išsivystyti generalizuota egzanteminė pustuliozė.…”

Section: Pulmonologija Ir Alergologijaunclassified

Nepageidaujamos imuninės reakcijos vartojant antikoaguliantus

Gasiūnienė¹

2020

PIA

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Antikoaguliantai yra plati medikamentų grupė, priklausanti skirtingoms farmakologinėms grupėms, turinti skirtingus veikimo mechanizmus ir galinti sukelti skirtingas nepageidaujamas imunines reakcijas. Nors antikoaguliantai retai sukelia alergines reakcijas, tačiau jos gali būti sunkios ir kelti pavojų gyvybei. Dažniausiai pasireiškia lėtosios padidėjusio jautrumo reakcijos, rečiau – II tipo (heparino indukuota trombocitopenija) bei greitojo tipo padidėjusio jautrumo reakcijos. Nepageidaujamų imuninių reakcijų antikoaguliantams diagnostika remiasi būdingais klinikiniais požymiais, odos alerginiais mėginiais bei provokaciniais mėginiais.

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Hypersensitivity reactions to non-vitamin K oral anticoagulants - a review of literature and diagnostic work-up proposal

Cited by 20 publications

References 22 publications

Complementary Use of U.S. FDA’s Adverse Event Reporting System and Sentinel System to Characterize Direct Oral Anticoagulants‐Associated Cutaneous Small Vessel Vasculitis

Complementary Use of U.S. FDA’s Adverse Event Reporting System and Sentinel System to Characterize Direct Oral Anticoagulants‐Associated Cutaneous Small Vessel Vasculitis

Role of direct oral anticoagulants in patients with kidney disease

Nepageidaujamos imuninės reakcijos vartojant antikoaguliantus

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