Drug Interactions and Direct Oral Anticoagulants.
- Arcsula Health
- Sep 8, 2022
- 1 min read
Anticoagulation therapy has changed significantly since the introduction of direct oral anticoagulants (DOACs), with several novel agents having been approved by the United States Food & Drug Administration (FDA) since 2010. These targeted drugs, also known as new oral anticoagulants (NOACs) or target-specific oral anticoagulants (TSOACs), specifically inhibit factors IIa or Xa in the coagulation cascade. They carry an improved safety profile, but are not without risk. DOACs may be preferred given their relative ease of use, improved pharmacokinetics, streamlined drug interaction profiles, and a lack of usual monitoring requirements. However, despite a reduced bleeding risk compared to warfarin, DOACs still have the potential for clinically-important drug interactions.
A study was recently published demonstrating the importance of continued drug interaction surveillance for this drug class. ¹Although infrequently used in this cohort post-DOAC, systemic antifungal treatment with azoles was shown to increase the risk of bleeding in patients in this 6-year Danish case-crossover study during involving nearly 100,000 individuals receiving a DOAC for atrial fibrillation. Individuals receiving apixaban plus fluconazole (a moderate CYP3A4 inhibitor), demonstrated a 3.5-fold increased risk of bleeding compared with periods when they were receiving apixaban without fluconazole (with gastrointestinal bleeding as the predominant site) suggesting the continued need for risk mitigation and monitoring of drugs in this important therapeutic class.
Reference:
1. Holt A, Strange JE, Rasmussen PV, Blanche P, Nouhravesh N, Jensen MH, Schjerning AM, Schou M, Torp-Pedersen C, Gislason GH, Hansen ML, McGettigan P, Lamberts M. Bleeding Risk Following Systemic Fluconazole or Topical Azoles in Patients with Atrial Fibrillation on Apixaban, Rivaroxaban, or Dabigatran. Am J Med. 2022 May;135(5):595-602.e5. doi: 10.1016/j.amjmed.2021.11.008. Epub 2021 Nov 30. PMID: 34861201.
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