DOAC use was associated with an increased risk of hospitalization for acute-onset interstitial lung diseases (adjusted OR 4.44; 95% CI 1.58-12.5).
Case-Control (n=178)
Does DOAC use increase the risk of hospitalization for acute-onset interstitial lung diseases in adult patients?
DOAC use is associated with a significantly increased risk of hospitalization for acute-onset interstitial lung diseases, highlighting the need for clinical monitoring of respiratory symptoms in DOAC users.
Effect estimate: adjusted OR 4.44 (95% CI 1.58-12.5)
BACKGROUND: Direct oral anticoagulants (DOACs) offer advantages over warfarin; however, concerns exist regarding their association with acute interstitial lung diseases (ILDs). This study investigated the risk of acute-onset ILDs associated with DOAC use. METHODS: We conducted a case-crossover study to assess the risk of hospitalization for acute-onset ILDs following DOAC initiation using the JMDC database, a Japanese administrative claims database. Patients aged ≥ 18 years hospitalized for acute-onset ILDs (April 2011-February 2023) were included. DOAC exposure was defined as ≥ 14 days within predefined 30-day windows: 1-30 days before admission (exposure period) and 60-90 and 120-150 days before admission (reference periods). The primary outcome was hospitalizations for acute-onset ILD, identified using a validated algorithm. Conditional logistic regression estimated odds ratios (ORs). Sensitivity analyses included a bidirectional case-crossover design, a case-crossover analysis with warfarin as an active comparator, weighted case-crossover analysis, and a case-case-time-control design. A descriptive cohort analysis of new DOAC and warfarin users examined ILD frequency and prognosis. RESULTS: The main case-crossover analysis included 178 patients, showing an association between DOAC use and acute-onset ILDs (adjusted OR, 4.44 95% CI, 1.58-12.5). Sensitivity analyses demonstrated a consistent direction of association (adjusted ORs: 3.37-6.85). In descriptive cohort analysis (52 021 DOAC and 12 026 warfarin initiators), ILD incidence was low (0.24% vs. 0.20%), but 90-day mortality was higher in the DOAC group (21% vs. 0%). CONCLUSIONS: DOAC use was associated with an increased risk of hospitalization for acute-onset ILDs. Clinicians should monitor patients on DOACs for ILD symptoms.
Anan et al. (Sat,) conducted a case-control in Acute interstitial lung diseases (ILDs) (n=178). Direct oral anticoagulants (DOACs) vs. Reference periods (60-90 and 120-150 days before admission) was evaluated on Hospitalizations for acute-onset ILD (adjusted OR 4.44, 95% CI 1.58-12.5). DOAC use was associated with an increased risk of hospitalization for acute-onset interstitial lung diseases (adjusted OR 4.44; 95% CI 1.58-12.5).