Key result
Concurrent use of levetiracetam and direct oral anticoagulants did not significantly affect the risk of ischemic stroke or transient ischemic attack (HR 0.99) in older patients with atrial fibrillation.
Why the study?
The study was conducted to analyze the influence of levetiracetam on direct oral anticoagulant exposure and its implications for clinical outcomes.
Does concurrent use of levetiracetam affect clinical outcomes or DOAC exposure in older patients with atrial fibrillation on DOAC therapy?
Cohort (n=885)
No
Does concurrent use of levetiracetam affect clinical outcomes or DOAC exposure in older patients with atrial fibrillation on DOAC therapy?
Hazard Ratio: 0.99 (95% CI 0.51–1.91)
Absolute Event Rate: 18.68% vs 11.82%
Concurrent levetiracetam may not increase ischemic events in older AF patients on DOACs; leaves open bleeding and exposure effects.
Objective This purpose of this study is to analyze the influence of levetiracetam (LEV) on direct oral anticoagulant (DOAC) exposure and its implications for clinical outcomes. Methods This investigation comprised a retrospective cohort study utilizing the integrated medical database and a prospective observational study conducted in a tertiary hospital. Patients aged >65 years with atrial fibrillation and undergoing DOAC therapy were included and were categorized as LEV users and non-users based on LEV exposure status. In retrospective cohort, clinical outcomes between LEV users and non-users were compared, included ischemic stroke or transient ischemic attack (IS/TIA), systemic thromboembolism (STE) and major bleeding. In prospective cohort, DOAC trough concentration was measured. Results The retrospective study included 191 LEV users and 694 matched LEV non-users. The risk of IS/TIA and STE were not significantly different between two groups (hazard ratio [HR], 0.99 [0.51–1.91] and 0.94 [0.49–1.79], respectively). For major bleeding, a non-significant higher risk was observed in the LEV-user group in contrast to the LEV-non-user group (HR 2.65 [0.43, 16.33]). The prospective analysis included 19 LEV users and 76 matched LEV non-users. Low DOAC concentrations were observed in 5.3% of LEV-users and 14.5% of LEV non-users ( P = 0.53). High DOAC concentration were observed in 10.5% of LEV-users and 11.8% LEV non-users (P = 0.57). The association between LEV therapy and low or high DOAC concentration was non-significant. Conclusion Concurrent use of LEV and DOAC did not significantly affect DOAC exposure or clinical outcomes. LEV may be a safe anti-seizure medication for patients receiving DOAC therapy.
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Huang et al. (2025) conducted a cohort in Atrial fibrillation (n=885). Levetiracetam vs. DOAC therapy without levetiracetam was evaluated on Ischemic stroke or transient ischemic attack (IS/TIA) (HR 0.99, 95% CI 0.51-1.91). Concurrent use of levetiracetam and direct oral anticoagulants did not significantly affect the risk of ischemic stroke or transient ischemic attack (HR 0.99) in older patients with atrial fibrillation.
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