Potential drug-drug interactions with NOACs were not significantly associated with an increased risk of major bleeding (HR 1.21; 95% CI 0.84-1.75; p=0.31) in patients with atrial fibrillation.
Cohort (n=1,732)
Yes
Does the presence of potential drug-drug interactions with NOACs increase the risk of adverse clinical outcomes in patients with atrial fibrillation?
In a real-world cohort of AF patients on NOACs, potential drug-drug interactions were common but not significantly associated with an increased risk of bleeding or ischemic stroke.
Hazard Ratio: 1.21 (95% CI 0.84–1.75)
p-value: p=0.31
Background The clinical relevance of drug-drug interactions associated with Non-vitamin K-antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients remains poorly understood. Objective We examined the prevalence of pharmacokinetic and pharmacodynamic drug-drug interactions and their association with adverse clinical outcomes in AF patients receiving NOACs. Methods We analyzed patients from the prospective, multicenter Swiss-AF cohort study. We employed frailty survival models to investigate the association of the different potential interactions with the respective clinical adverse outcomes (major bleeding, clinically relevant non-major bleeding, any bleeding, ischemic stroke/systemic embolism). Results Our analysis comprised 1732 AF patients (mean age 73 ± 8 years, 501 29% females) with a median follow-up period of 6 years. For 683 (39%) of these patients, we recorded at least one potential drug-drug interaction. In the multivariable adjusted model, the HR of drug-drug interaction was 1.21 (95% CI 0.84; 1.75, p=0.31) for major bleeding, 1.22 (95% CI 0.92; 1.62, p=0.17) for clinically relevant non-major bleeding, 1.22 (95% CI 0.97; 1.54, p=0.09) for any bleeding, and 1.00 (95% CI 0.22; 4.53, p=0.99) for ischemic stroke/systemic embolism. Conclusions In a large real-world cohort of AF patients, the prevalence of potential interactions of long-term comedication with NOACs was high. We found no strong evidence of an association between these interactions and an increased risk of bleeding or ischemic stroke/systemic embolism.
Hennings et al. (Mon,) conducted a cohort in Atrial fibrillation (n=1,732). Drug-drug interactions of NOACs with comedication vs. No drug-drug interaction was evaluated on Major bleeding (HR 1.21, 95% CI 0.84; 1.75, p=0.31). Potential drug-drug interactions with NOACs were not significantly associated with an increased risk of major bleeding (HR 1.21; 95% CI 0.84-1.75; p=0.31) in patients with atrial fibrillation.