Key result
Direct oral anticoagulants offer a safer alternative to vitamin K antagonists, but their safety is affected by pharmacokinetic and pharmacodynamic interactions with other drugs and food.
Clinicians must be vigilant regarding pharmacokinetic and pharmacodynamic interactions when prescribing oral anticoagulants, particularly DOACs combined with antiplatelets or NSAIDs in high-risk patients.
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Interactions with DOACs require clinical vigilance in polypharmacy; leaves open optimal mitigation strategies in high-risk groups.
Vitamin K antagonists (VKAs) such as warfarin are the most commonly prescribed oral anticoagulants worldwide. However, factors affecting the pharmacokinetics of VKAs, such as food and drugs, can cause deviations from their narrow therapeutic window, increasing the bleeding or thrombosis risk and complicating their long-term use. The use of direct oral anticoagulants (DOACs) offers a safer and more convenient alternative to VKAs. However, it is important to be aware that plasma levels of DOACs are affected by drugs that alter the cell efflux transporter P-glycoprotein and/or cytochrome P450. In addition to these pharmacokinetic-based interactions, DOACs have the potential for pharmacodynamic interaction with antiplatelet agents and non-steroidal anti-inflammatory drugs. This is an important consideration in patient groups already at high risk of bleeding, such as patients with renal impairment.
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Vranckx et al. (2018) conducted a review in Oral anticoagulation therapy. Oral anticoagulants (VKAs and DOACs) was evaluated. Direct oral anticoagulants offer a safer alternative to vitamin K antagonists, but their safety is affected by pharmacokinetic and pharmacodynamic interactions with other drugs and food.
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