This critical review highlights the potential for pharmacokinetic and pharmacodynamic interactions between oral anticoagulants (VKAs and DOACs) and drugs, foods, herbs, and over-the-counter medications.
What are the potential interactions of old and new oral anticoagulants with drugs, foods, herbs, and over-the-counter medications?
This review highlights the importance of recognizing pharmacokinetic and pharmacodynamic interactions between oral anticoagulants (both VKAs and DOACs) and various foods, herbs, and medications to prevent bleeding or thrombotic complications.
The most commonly prescribed oral anticoagulants worldwide are the vitamin K antagonists (VKAs) such as warfarin. Factors affecting the pharmacokinetics of VKAs are important because deviations from their narrow therapeutic window can result in bleedings due to over-anticoagulation or thrombosis because of under-anticoagulation. In addition to pharmacodynamic interactions (e.g., augmented bleeding risk for concomitant use of NSAIDs), interactions with drugs, foods, herbs, and over-the-counter medications may affect the risk/benefit ratio of VKAs. Direct oral anticoagulants (DOACs) including Factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and thrombin inhibitor (dabigatran) are poised to replace warfarin. Phase-3 studies and real-world evaluations have established that the safety profile of DOACs is superior to those of VKAs. However, some pharmacokinetic and pharmacodynamic interactions are expected. Herein we present a critical review of VKAs and DOACs with focus on their potential for interactions with drugs, foods, herbs and over-the-counter medications.
Minno et al. (Sun,) conducted a review in Patients requiring oral anticoagulation. Oral anticoagulants (VKAs and DOACs) was evaluated. This critical review highlights the potential for pharmacokinetic and pharmacodynamic interactions between oral anticoagulants (VKAs and DOACs) and drugs, foods, herbs, and over-the-counter medications.