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. 2023 Apr 4;23(1):182.
doi: 10.1186/s12872-023-03212-z.

Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation

Ki Won Hwang #  1 , Jin Hee Choi #  2 , Soo Yong Lee  2 , Sang Hyun Lee  2 , Min Ku Chon  2 , Jungkuk Lee  3 , Hasung Kim  3 , Yong-Giun Kim  4 , Hyung Oh Choi  5 , Jeong Su Kim  2 , Yong-Hyun Park  2 , June Hong Kim  2 , Kook Jin Chun  2 , Gi-Byoung Nam  6 , Kee-Joon Choi  6
Affiliations

Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation

Ki Won Hwang et al. BMC Cardiovasc Disord. .

Abstract

Background: Evidence and guidelines for Non-vitamin K antagonist oral anticoagulants (NOACs) use when prescribing concurrent rifampin for tuberculosis treatment in patients with non-valvular atrial fibrillation (NVAF) are limited.

Methods: Using the Korean National Health Insurance Service database from January 2009 to December 2018, we performed a population-based retrospective cohort study to assess the net adverse clinical events (NACE), a composite of ischemic stroke or systemic embolism and major bleeding, of NOACs compared with warfarin among NVAF patients taking concurrent rifampin administration for tuberculosis treatment. After a propensity matching score (PSM) analysis, Cox proportional hazards regression was performed in matched cohorts to investigate the clinical outcomes.

Results: Of the 735 consecutive patients selected, 465 (63.3%) received warfarin and 270 (36.7%) received NOACs. Among 254 pairs of patients after PSM, the crude incidence rate of NACE was 25.6 in NOAC group and 32.8 per 100 person-years in warfarin group. There was no significant difference between NOAC and warfarin use in NACE (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.48-1.14; P = 0.172). Major bleeding was the main driver of NACE, and NOAC use was associated with a statistically significantly lower risk of major bleeding than that with warfarin use (HR, 0.63; 95% CI, 0.40-1.00; P = 0.0499).

Conclusions: In our population-based study, there was no statically significant difference in the occurrence of NACE between NOAC and warfarin use. NOAC use may be associated with a lower risk of major bleeding than that with warfarin use.

Keywords: Anticoagulation; Atrial fibrillation; Drug-drug interactions; Rifampin; Tuberculosis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Enrollement flow of study patients. AF, atrial fibrillation; OAC, oral anticoagulant; TB, tuberculosis; NOAC, non–vitamin K antagonist oral anticoagulant
Fig. 2
Fig. 2
Trend in Non–vitamin K Antagonist Oral Anticoagulant (NOAC) and warfarin among patients with concurrent rifampin administration before (A) and after (B) propensity score matching
Fig. 3
Fig. 3
Cumulative Incidence Curves of Clinical Events Among the Propensity Score–Matched Cohort Using the Kaplan-Meier Method (A) Net adverse clinical events (B) Ischemic stroke or systemic embolism (C) Major bleeding (D) Intracranial hemorrhage (E) Gastrointestinal bleeding (F) All cause death
Fig. 4
Fig. 4
Risk of Net Adverse Clinical Events Associated With Non–vitamin K Antagonist Oral Anticoagulant (NOAC) Use Compared With Warfarin Use in Different Subgroups. MI, myocardial infarction; TIA, transient ischemic accident; SSE, systemic embolism; COPD, chronic obstructive pulmonary disease; CI, confidence interval
See this image and copyright information in PMC

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