Key result
Concurrent DOAC and antiepileptic therapy in NVAF shows a 5.7% annual thromboembolic event rate.
Why the study?
Guidelines advise against using certain antiepileptic drugs with DOACs, but the clinical relevance of this drug-drug interaction was poorly understood.
Cohort (n=91)
Yes
Patients with non-valvular atrial fibrillation concurrently treated with DOACs and antiepileptic drugs experience a relatively high rate of thromboembolic events (5.7% patient-year), suggesting a clinically relevant drug-drug interaction.
Concurrent DOAC-antiepileptic co-prescription was associated with elevated thromboembolic risk in NVAF; leaves open whether interactions drive outcomes and require prospective trials.
BACKGROUND: European guidelines do not recommend the use of carbamazepine, levetiracetam, phenobarbital, phenytoin, topiramate and valproic acid in patients taking direct oral anticoagulants (DOACs). Little is known regarding the clinical relevance of the interaction between DOACs and antiepileptic drugs. OBJECTIVES: To evaluate the incidence of thromboembolic and bleeding events in patients with non-valvular atrial fibrillation (AF) concurrently treated with DOACs and antiepileptic drugs. METHODS: This is a prospective multicentre cohort study of patients with non-valvular AF concurrently treated with DOACs and antiepileptic drugs. The primary outcome was ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE). Secondary outcome was major bleeding (MB). Incidence rates (% patient-year) were evaluated for the study outcomes. RESULTS: -VASc score was 4.76 ± 1.59 and mean HAS-BLED was 2.67 ± 1.26. Overall, 41, 20, 11, 10 and 9 out of 91 patients were treated with levetiracetam, valproic acid, phenobarbital, carbamazepine and other antiepileptic drugs, respectively. During a median follow-up of 17.5 ± 14.5 months, stroke/TIA/SE occurred in 9 patients (5.7% patient-year) and MB in 3 patients (1.9% patient-year). Ischaemic stroke was fatal in 3 patients (1.9% patient-year) and MB in one patient (0.6% patient-year). CONCLUSION: In this cohort, patients with non-valvular AF treated with DOACs and antiepileptic drugs appear to have a relatively high rate of thromboembolic events.
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Giustozzi et al. (2020) conducted a cohort in Non-valvular atrial fibrillation (n=91). Direct oral anticoagulants (DOACs) and antiepileptic drugs (AEDs) was evaluated on Composite of ischaemic stroke, transient ischaemic attack (TIA), and systemic embolism (SE). Patients with non-valvular atrial fibrillation concurrently treated with direct oral anticoagulants and antiepileptic drugs had a thromboembolic event rate of 5.7% per patient-year.
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