We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.
We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.
The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.
Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
You can find your saved items on your dashboard, in the "saved" tab.
You've recommended your first item
Your recommendations help us improve our content suggestions for you and other PracticeUpdate members.
You've subscribed to your first topic alert
What does that mean?
Each day, we'll check to see if new items have been published to the topics you're subscribed to, and we'll send you one email with all of the new items from that day.
We'll keep all topic alert notifications available on your dashboard for 30 days, to make sure you don't miss anything.
Lastly, whenever you have unread items in the topics you've subscribed to, the "Alerts" icon will light up in the main menu. Just click on the bell to see your five most-recent, unread notifications.
Direct-acting oral anticoagulants (DOACs) are mainly affected by medications strongly affecting the permeability glycoprotein (P-gp) and, to a lesser extent, strong CYP3A4 inhibitors/inducers. Strong inhibitors/inducers of CYP2C9, CYP3A4, and CYP1A2 may affect warfarin in drug–drug interactions. Strong inducers of CYP3A4 or P-gp should be avoided in all patients taking DOACs, whereas simultaneous use of strong CYP3A4 and P-gp inhibitors should be avoided in patients taking apixaban and rivaroxaban. Dabigatran and edoxaban are affected by P-gp modulation. Concomitant antiplatelet/anticoagulant use confers an additive risk for bleeding.
Minimizing the duration of concomitant anticoagulant/antiplatelet therapy, as indicated by evidence-based clinical guidelines, is the best way to reduce the risk of bleeding.
Oral anticoagulants (OACs) are medications commonly used in patients with atrial fibrillation and other cardiovascular conditions. Both warfarin and direct oral anticoagulants are susceptible to drug-drug interactions (DDIs). DDIs are an important cause of adverse drug reactions and exact a large toll on the health care system. DDI for warfarin mainly involve moderate to strong inhibitors/inducers of cytochrome P450 (CYP) 2C9, which is responsible for the elimination of the more potent S-isomer of warfarin. However, inhibitor/inducers of CYP3A4 and CYP1A2 may also cause DDI with warfarin. Recognition of these precipitating agents along with increased frequency of monitoring when these agents are initiated or discontinued will minimize the impact of warfarin DDI. Direct oral anticoagulants are mainly affected by medications strongly affecting the permeability glycoprotein (P-gp), and to a lesser extent, strong CYP3A4 inhibitors/inducers. Dabigatran and edoxaban are affected by P-gp modulation. Strong inducers of CYP3A4 or P-gp should be avoided in all patients taking direct oral anticoagulant unless previously proven to be otherwise safe. Simultaneous strong CYP3A4 and P-gp inhibitors should be avoided in patients taking apixaban and rivaroxaban. Concomitant antiplatelet/anticoagulant use confers additive risk for bleeding, but their combination is unavoidable in many cases. Minimizing duration of concomitant anticoagulant/antiplatelet therapy as indicated by evidence-based clinical guidelines is the best way to reduce the risk of bleeding.
Drug Interactions Affecting Oral Anticoagulant Use
Circ Arrhythm Electrophysiol 2022 May 27;[EPub Ahead of Print], PL Mar, R Gopinathannair, BE Gengler, MK Chung, A Perez, J Dukes, MD Ezekowitz, D Lakkireddy, GYH Lip, M Miletello, PA Noseworthy, J Reiffel, JE Tisdale, B Olshansky