Key result
The presence of at least one interacting medication was numerically but not significantly higher in DOAC patients with major bleeding compared to controls (85% vs 72%, P=0.077).
Why the study?
Although DOACs have fewer drug interactions than warfarin, drug-drug interactions can still occur, and evidence showing their total impact on major bleeding is limited.
Does the concomitant use of interacting medications increase the risk of major bleeding events in patients taking direct oral anticoagulants?
Case-Control (n=122)
No
Does the concomitant use of interacting medications increase the risk of major bleeding events in patients taking direct oral anticoagulants?
Absolute Event Rate: 85% vs 72%
p-value: p=.077
The concomitant use of three or more interacting medications, particularly aspirin and rate control agents, may cumulatively increase the risk of major bleeding in patients taking DOACs.
Background: While direct oral anticoagulants (DOACs) have less stringent monitoring, favorable pharmacokinetics, and fewer drug interactions compared to warfarin, there is still a potential for drug–drug interactions. There is limited evidence showing total impact of DOAC drug interactions on major bleeding events. Methods: This was an IRB-approved retrospective, case control, single center study. Patients were included if they had received a DOAC from January 2012 to September 2019 and were identified for major bleeding events and matched to a control group. The primary objective was to compare the presence of major drug interactions between patients on DOACs who did and did not have a major bleeding event. The secondary objectives were to compare the impact of specific interacting drug classes and their additive effects on major bleeding events. Results: There were 122 patients included in the study. While the number of patients on at least one interacting medication within duration of DOAC use was numerically higher in the bleed group (85% vs 72%), this was not significant (P = .077). There were significantly more patients on at least three interacting medications within the last 3 months of the study period in the bleed group (n = 9 vs 1), with significantly higher use of aspirin (n = 38 vs 17) and rate control agents (n = 24 vs 11). Conclusion: There may be a cumulative effect on risk of bleeding if patients are on three or more interacting medications concomitantly with a DOAC. This risk of bleeding may be higher with aspirin and rate control agents.
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Cook et al. (2022) conducted a case-control in Patients taking direct oral anticoagulants (DOACs) (n=122). At least one interacting medication vs. No interacting medication was evaluated on Presence of major drug interactions (at least one interacting medication) (p=.077). The presence of at least one interacting medication was numerically but not significantly higher in DOAC patients with major bleeding compared to controls (85% vs 72%, P=0.077).
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