Drug Interactions Affecting Oral Anticoagulant Use
| Autor: | Mar, Philip L., Gopinathannair, Rakesh, Gengler, Brooke E., Chung, Mina K., Perez, Arturo, Dukes, Jonathan, Ezekowitz, Michael D., Lakkireddy, Dhanunjaya, Lip, Gregory Y. H., Miletello, Mike, Noseworthy, Peter A., Reiffel, James, Tisdale, James E., Olshansky, Brian |
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| Rok vydání: | 2022 |
| Předmět: |
glycoprotein
anticoagulants Pyridones apixaban Administration Oral Hemorrhage Warfarin/adverse effects Article Rivaroxaban Pyridones/adverse effects Hemorrhage/chemically induced Physiology (medical) Atrial Fibrillation Cytochrome P-450 CYP3A Humans atrial fibrillation Drug Interactions Cytochrome P-450 CYP3A/therapeutic use Rivaroxaban/therapeutic use Anticoagulants Dabigatran warfarin Warfarin Anticoagulants/adverse effects Cardiology and Cardiovascular Medicine Atrial Fibrillation/complications |
| Zdroj: | Mar, P L, Gopinathannair, R, Gengler, B E, Chung, M K, Perez, A, Dukes, J, Ezekowitz, M D, Lakkireddy, D, Lip, G Y H, Miletello, M, Noseworthy, P A, Reiffel, J, Tisdale, J E, Olshansky, B & from the American Heart Association Electrocardiography & Arrhythmias Committee of the Council of Clinical Cardiology 2022, ' Drug Interactions Affecting Oral Anticoagulant Use ', Circulation. Arrhythmia and Electrophysiology, vol. 15, no. 6, e007956 . https://doi.org/10.1161/CIRCEP.121.007956 Circ Arrhythm Electrophysiol |
| ISSN: | 1941-3084 1941-3149 |
| DOI: | 10.1161/circep.121.007956 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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