Med. praxi. 2018;15(5):267-275 | DOI: 10.36290/med.2018.049

Drug-drug interactions of warfarin and new direct oral anticoagulans

MUDr. Michal Prokeš, PharmDr. Josef Suchopár
DrugAgency, a.s., Praha

Anticoagulation therapy with warfarin and direct oral anticoagulants annually saves lives of many patients. These patients oftentake medicines that change the effect of anticoagulants. This article attempts to present in a synopical way information about suchinteractions that physicians prescribe. Although warfarin has more interactions than DOAC, some DOAC interactions are equallydangerous and, unlike warfarin, the effect of DOAC cannot be easily monitored. This may be a problem because there are patients inwhom the drug interaction is more intense than in average patients, for example when dabigatran is combined with clarithromycin.

Keywords: drug-drug interactions, warfarin, NOAC, DOAC, clarithromycin

Published: December 1, 2018  Show citation

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Prokeš M, Suchopár J. Drug-drug interactions of warfarin and new direct oral anticoagulans. Med. praxi. 2018;15(5):267-275. doi: 10.36290/med.2018.049.
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    References

    1. Bultas J. Nová perorální antikoagulancia - přednosti a úskalí léčby. Gastroent Hepatol 2015; 69(2): 152-160. Go to original source...
    2. Bultas J, Karetová D. Výběr nemocných k léčbě DOAC - co zohlednit? Interní medicína pro praxi, 2015; 17(3): 118-122.
    3. Bultas J, Karetová D. Nová perorální antikoagulancia - o čem se nemluví. Remedia, 2015; 25(2): 127-134.
    4. Karetová D. Postavení přímých orálních antikoagulancií v léčbě žilní trombózy (up to date 2018) Medicína po promoci, 2018; 19(2): 140-144.
    5. Cheng JW, Barillari. Non-vitamin K antagonist oral anticoagulants in cardiovascular disease management: evidence and unanswered questions. J Clin Pharmacol Ther 2014; 39: 118-135. Go to original source... Go to PubMed...
    6. Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug-drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ 2007; 177(4): 347-351. Go to original source... Go to PubMed...
    7. Hellwig T, Gulseth M. Pharmacokinetic and pharmacodynaic drug interactions with new oral anticoagulants: What do they mean for patients with atrial fibrillation? Am Pharmacother 2013; 47: 1478-1487. Go to original source... Go to PubMed...
    8. Davidson BL, Verheijen S, Lensing AW, et al. Bleeding risk of patients with acute venous thromboembolism taking nonsteroidal anti-inflammatory drugs or aspirin. JAMA Intnern Med 2014; 174 (6): 947-953. Go to original source... Go to PubMed...
    9. Mueck W, Kubitza D, Becka M. Co-administration of rivaroxaban with drugs that share its elimination pathways: pharmacokinetic effects in healthy subjects. Br J Clin Pharmacol 2013; 76: 455-466. Go to original source... Go to PubMed...
    10. Delavenne X, Ollier E, Basset T, et al. A semi-mechanistic absorption model to evaluate drug-drug interaction with dabigatran: application with clarithromycin. Br J Clin Pharmacol 2013; 76(1): 107-113. Go to original source... Go to PubMed...
    11. Gouin-Thibault I, Delavenne X, Blanchard A, et al. interindividual variability in dabigatran and rivaroxaban exposure: contribution of ABCB1 genetic polymorphism and interaction with clarithromycin. J Thromb Haemost 2017; 15(2): 273-283. Go to original source... Go to PubMed...
    12. SPC přípravku Pradaxa(R) (dabigatran-etexilat), Boehringer Ingelheim, 2018, EMA: http://www.ema.europa.eu/docs/cs_CZ/document_library/EPAR_-_Product_Information/human/000829/WC500041059.pdf
    13. SPC přípravku Xarelto(R) (rivaroxaban), Bayer Pharma, 2018, http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000944/human_med_001155.jsp&mid=WC0b01ac058001d124
    14. SPC přípravku Eliquis(R) (apixaban), Bristol Myers Squibb/Pfizer EEIG, 2018, EMA: http://www.ema.europa.eu/docs/cs_CZ/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf
    15. SPC přípravku Lixiana(R) (edoxaban), Daiichi Sankyo Europe, 2017 EMA: http://www.ema.europa.eu/docs/cs_CZ/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf
    16. Křížková J. Klinicky významné interakce antibiotik. Předneseno na XXII. pracovním dnu klinické farmacie, 1.6.2018, Lékařský dům ČLS JEP, Praha 2.
    17. Chang SH, Chou IJ, Yeh YH. Association between use of non-vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrilation. JAMA 2017; 318(3): 1250-1259. Go to original source... Go to PubMed...
    18. Westergren T, Jonansson P, Molden E. Probable warfarin-simvastatin interaction. Ann Pharmacother 2007; 41(7): 1292-1295. Go to original source... Go to PubMed...
    19. Andersson ML, Eliasson E, Lindh JD. A clinically significant interaction between the warfarin and simvastatin is unique to carrirers of the CYP2C9*3 alelle. Pharmacogenomics 2012; 13(7): 757-762. Go to original source... Go to PubMed...
    20. Frost C, Shenker A, Gandhi MD, et al. Evaluation of the effect of naproxen on the pharmacokinetics and pharmacodynamics of apixaban. Br J Clin Pharmacol 2014; 78: 877-885. Go to original source... Go to PubMed...
    21. SPC přípravku Warfarin Orion (warfarin), 2017 (http://www.sukl.cz/modules/medication/search.php)
    22. Harper P, Young L, Merriman E. Bleeding risk with dabigatran in the frail elderly. N Engl J Med 2012; 366: 864-866. Go to original source... Go to PubMed...
    23. Sorensen R, Gaislason G, Torp-Pederson C, et al. Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study. Br Med J Open 2013; 3(5). pii: e002758. doi: 10.1136/bmjopen-2013-002758. Go to original source... Go to PubMed...
    24. Hernandez I, Baik SH, Pinera A, Zhang Y: Risk of bleeding with dabigatran in atrial fibrillation. JAMA Intern Med 2015; 175(1): 18-24, doi: 10 1001/jamainternmed.2014.8398. Go to original source... Go to PubMed...
    25. Tronsco A, Diogene E. Dabigatran and rivaroxaban prescription for atrial fibrillation in Catalonia, Spain: the need to manage the indtoruction of new medicines. Eur J Clin Pharmacol 2014; 70: 249-250. Go to original source... Go to PubMed...
    26. Česká kardiologická společnost: Aktualizace doporučení ESC z roku 2017 zaměřená na duální protidestičkovou léčbu u nemocných s ischemickou chorobou srdeční, vytvořená ve spolupráci s EACTS. http://www.kardio-cz.cz/data/upload/doporucene_postupy/2017/Aktualizace_doporuceni_ESC_z_roku_2017_zamena_na_dualni_protidestickovou_lecbu_u_nemocnych_s_ischemickou_chorobou_srdecni_vytvoena_ve_spolupraci_s_EACTS.pdf
    27. Matýšková M, Michalcová J, Penka M. Antitrombotika dnes. Vnitř Lék 2018; 64(5): 565-574. Go to original source... Go to PubMed...

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