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. 2021 Oct;77(10):1435-1441.
doi: 10.1007/s00228-020-03074-w. Epub 2021 Apr 24.

Drug-drug interactions between vitamin K antagonists and statins: a systematic review

Anna E Engell  1 , Andreas L O Svendsen  2 , Bent S Lind  3   4 , Tore Bjerregaard Stage  5 , Maja Hellfritzsch  5   6 , Anton Pottegård  5
Affiliations

Drug-drug interactions between vitamin K antagonists and statins: a systematic review

Anna E Engell et al. Eur J Clin Pharmacol. 2021 Oct.

Abstract

Purpose: Concomitant use of vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review to evaluate the effect of statin initiation on coagulation among VKA users.

Methods: Following the PRISMA guidelines, we applied two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed; 8623 unique hits were obtained. In the final sample, eight studies were included.

Results: The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65.

Conclusion: The anticoagulant effect of statin initiation in patients treated with VKA is likely to be of limited clinical relevance but should be evaluated individually.

Keywords: Anticoagulants; Drug interactions; Statins; Vitamin K antagonists; Warfarin.

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References

    1. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G (2012) Oral anticoagulant therapy - antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e44S–e88S. https://doi.org/10.1378/chest.11-2292 - DOI - PubMed - PMC
    1. Ufer M (2005) Comparative pharmacokinetics of vitamin K antagonists. Clin Pharmacokinet 44:1227–1246. https://doi.org/10.2165/00003088-200544120-00003 - DOI - PubMed
    1. Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, Wells PS (2005) Systematic overview of warfarin and its drug and food interactions. Arch Intern Med 165:1095–1106. https://doi.org/10.1001/archinte.165.10.1095 - DOI - PubMed
    1. Beinema M, Brouwers JRBJ, Schalekamp T, Wilffert B (2008) Pharmacogenetic differences between warfarin, acenocoumarol and phenprocoumon. Thromb Haemost 100:1052–1057 - DOI
    1. Desai CS, Martin SS, Blumenthal RS (2014) Non-cardiovascular effects associated with statins. BMJ 349:1–10. https://doi.org/10.1136/bmj.g3743 - DOI

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