June 11, 2014Seminars in Thrombosis and Hemostasis
Combined Administration of Antibiotics and Direct Oral Anticoagulants: A Renewed Indication for Laboratory Monitoring?
Key result
Combined administration of direct oral anticoagulants and certain antibiotics alters anticoagulant bioavailability and metabolism, potentially requiring laboratory monitoring and dose adjustments.
Why the study?
Does the combined administration of antibiotics and DOACs alter anticoagulant effect and increase the risk of hemorrhagic or thrombotic events in patients requiring long-term anticoagulation?
Population
Patients requiring long-term anticoagulation
Design
Review
Authors
Discussion
Loading...
Member takes
Implication
May prompt monitoring with select antibiotics in DOAC-treated patients; leaves open event risks and optimal strategies for prospective validation.
Structured PICO
Does the combined administration of antibiotics and DOACs alter anticoagulant effect and increase the risk of hemorrhagic or thrombotic events in patients requiring long-term anticoagulation?
P
Population
Patients requiring long-term anticoagulation
E
Exposure
Combined administration of direct oral anticoagulants (DOACs: dabigatran, rivaroxaban, apixaban, edoxaban) and antibiotics (e.g., clarithromycin, rifampicin, erythromycin, fluconazole, ketoconazole, amoxicillin, cephalosporin, metronidazole)
O
Outcome
Drug-to-drug interactions altering bioavailability or metabolism, and hemorrhagic or thrombotic eventssafety
The co-administration of DOACs and certain antibiotics may alter anticoagulant metabolism and bioavailability, suggesting a potential need for laboratory monitoring and dose adjustments to prevent bleeding or thrombosis.
Limitations
- No published data were found for apixaban and edoxaban, or for potential interactions of DOACs with other widely used antibiotics.
- No published data found for apixaban and edoxaban
- Reliance on online resources and social media information for some adverse event reports
Cite This Study
Favaloro et al. (2014) conducted a review in Patients requiring long-term anticoagulation. Combined administration of direct oral anticoagulants and antibiotics was evaluated. Combined administration of direct oral anticoagulants and certain antibiotics alters anticoagulant bioavailability and metabolism, potentially requiring laboratory monitoring and dose adjustments.