Drug-Drug Interactions with Direct Oral Anticoagulants.

Clinical Pharmacokinetics
Kathrin I FoersterWalter E Haefeli

Abstract

A large body of evidence suggests that not only direct anticoagulant effects but also major bleeding events and stroke prevention depend on plasma concentrations of direct oral anticoagulants (DOACs). Concomitant drugs that cause drug-drug interactions (DDIs) alter DOAC exposure by increasing or decreasing DOAC bioavailability and/or clearance; hence, they might affect the efficacy and safety of DOAC therapy. Patients with renal impairment already receive smaller DOAC maintenance doses because avoidance of elevated DOAC exposure might prevent serious bleeding events. For other causes of increased exposure such as DDIs, management is often less well-defined. Considering that DOAC patients are often older and have multiple co-morbidities, polypharmacy is highly prevalent. However, the effect of multiple drugs on DOAC exposure, and especially the impact of DDIs when concurring with drug-disease interactions as observed in renal impairment, has not been thoroughly elucidated. In order to provide effective and safe anticoagulation with DOACs, understanding the mechanisms and magnitude of DDIs appears relevant. Instead of avoiding drug combinations with DOACs, more DDI trials should be conducted and new strategies such as dose adjust...Continue Reading

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Citations

Aug 29, 2020·Journal of Cardiovascular Medicine·Silvia FrattiniGian B Danzi
Apr 17, 2020·Internal and Emergency Medicine·Sophie TestaAngelo Pan
Nov 3, 2020·Annals of Internal Medicine·Maja HellfritzschLars Peter Nielsen
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Aug 29, 2020·The American Journal of Medicine·Laura BarboliniJean-Luc Reny
Apr 24, 2021·Journal of Community Hospital Internal Medicine Perspectives·Ragia AlySorab Gupta
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Jun 19, 2021·Cardiovascular Drugs and Therapy·Robert BenamouzigLaurent Fauchier
Jun 15, 2021·Frontiers in Pharmacology·Roberta RobertiRita Citraro

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