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. 2018 Mar;7(1):55-61.
doi: 10.15420/aer.2017.50.1.

The Significance of Drug-Drug and Drug-Food Interactions of Oral Anticoagulation

Pascal Vranckx  1 , Marco Valgimigli  2 , Hein Heidbuchel  3
Affiliations

The Significance of Drug-Drug and Drug-Food Interactions of Oral Anticoagulation

Pascal Vranckx et al. Arrhythm Electrophysiol Rev. 2018 Mar.

Abstract

Vitamin K antagonists (VKAs) such as warfarin are the most commonly prescribed oral anticoagulants worldwide. However, factors affecting the pharmacokinetics of VKAs, such as food and drugs, can cause deviations from their narrow therapeutic window, increasing the bleeding or thrombosis risk and complicating their long-term use. The use of direct oral anticoagulants (DOACs) offers a safer and more convenient alternative to VKAs. However, it is important to be aware that plasma levels of DOACs are affected by drugs that alter the cell efflux transporter P-glycoprotein and/or cytochrome P450. In addition to these pharmacokinetic-based interactions, DOACs have the potential for pharmacodynamic interaction with antiplatelet agents and non-steroidal anti-inflammatory drugs. This is an important consideration in patient groups already at high risk of bleeding, such as patients with renal impairment.

Keywords: Apixaban; dabigatran; direct oral anticoagulants; drug—drug interactions; edoxaban; rivaroxaban; vitamin K antagonists; warfarin.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. The Vitamin K Cycle and Anticoagulation
Figure 2:
Figure 2:. Absorption and Metabolism of Direct Oral Anticoagulants
See this image and copyright information in PMC

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