Key result
DOACs show no difference in thromboembolic events vs. warfarin during concurrent rifampin therapy.
Why the study?
Rifampin reduces oral anticoagulant levels, raising concerns about increased thrombotic risk, but comparative clinical outcome data between rifampin plus warfarin versus direct oral anticoagulants were limited.
Does the coadministration of rifampin with warfarin compared to DOACs affect the risk of ischemic, thromboembolic, and bleeding events in patients requiring anticoagulation?
Cohort (n=142)
No
Does the coadministration of rifampin with warfarin compared to DOACs affect the risk of ischemic, thromboembolic, and bleeding events in patients requiring anticoagulation?
There were no significant differences in the incidence of thrombotic or bleeding events between warfarin and DOACs when coadministered with rifampin, though close monitoring for bleeding is necessary in high-risk patients.
Answers are grounded in this paper and cite their sources.
Comparable event rates with DOACs and warfarin plus rifampin should not yet change practice; leaves open need for larger randomized confirmation.
Introduction: Pharmacokinetic studies have shown that rifampin reduces the levels of oral anticoagulants during the initiation of coadministration, raising concerns about an increased thrombotic risk, but there are limited comparative clinical outcomes between rifampin and warfarin compared with direct oral anticoagulants (DOACs). This study aimed to evaluate the effectiveness and safety of concurrent use of rifampin and warfarin versus DOACs, with assessments of outcome-associated factors and oral anticoagulant (OAC) management quality. Methods: = 86) for over 7 days were included, and their clinical data and outcomes were compared. Results: The median Charlson Comorbidity Index and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly) score of the two groups were 2 and 3, respectively. The incidence rate of composite ischemic or thromboembolic events was 2.16 and 1.44 per 10,000 patient-days in the warfarin and DOAC groups, respectively, with an adjusted hazard ratio (HR) of 0.41 (95% confidence interval [CI] 0.02-7.34). The incidence rate of composite major bleeding or clinically relevant nonmajor bleeding events was 1.58 and 1.52 per 10,000 patient-days in the warfarin and DOAC groups, respectively, with an adjusted HR of 1.12 (95% CI 0.32-4.45). The risk of composite bleeding events increased with a higher HAS-BLED score (HR: 1.62, 95% CI: 1.02-2.63). Moreover, 34.3% of warfarin users maintained a percent time in therapeutic range of above 50%. Furthermore, 77.9% of DOAC users received appropriate dosing. Conclusion: No significant differences were observed in terms of the incidence of thrombotic or bleeding events between the two groups during coadministration. In addition, a higher HAS-BLED score was associated with a greater risk of bleeding events regardless of the class of OACs used. Finally, close monitoring of bleeding events should be considered.
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Wung et al. (2024) conducted a cohort in Patients requiring oral anticoagulation and concurrent rifampin therapy (n=142). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Composite ischemic or thromboembolic events (adjusted HR 0.41, 95% CI 0.02-7.34). Direct oral anticoagulants showed no significant difference in the incidence of composite ischemic or thromboembolic events compared to warfarin during concurrent use with rifampin (adjusted HR 0.41).
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