Drug-drug interactions in an era of multiple anticoagulants: a focus on clinically relevant drug interactions

Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):339-347. doi: 10.1182/asheducation-2018.1.339.

Abstract

Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p-glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed. New data on anticoagulant drug interactions are available almost daily, and therefore, it is vital that clinicians regularly search interaction databases and the literature for updated management strategies. Skilled drug interaction management will improve outcomes and prevent adverse events in patients taking oral anticoagulants.

Publication types

  • Review

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B / metabolism
  • Administration, Oral
  • Anti-Inflammatory Agents, Non-Steroidal* / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal* / therapeutic use
  • Anticoagulants* / adverse effects
  • Anticoagulants* / therapeutic use
  • Cytochrome P-450 CYP2C9 / metabolism
  • Cytochrome P-450 CYP3A / metabolism
  • Drug Interactions
  • Humans
  • Platelet Aggregation Inhibitors* / adverse effects
  • Platelet Aggregation Inhibitors* / therapeutic use
  • Selective Serotonin Reuptake Inhibitors* / adverse effects
  • Selective Serotonin Reuptake Inhibitors* / therapeutic use

Substances

  • ATP Binding Cassette Transporter, Subfamily B
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Serotonin Uptake Inhibitors
  • CYP2C9 protein, human
  • Cytochrome P-450 CYP2C9
  • Cytochrome P-450 CYP3A
  • CYP3A4 protein, human