Key result
A potential or likely drug-drug interaction was identified for 12% of the 400 evaluated DOAC-antineoplastic agent pairs, though at least one DOAC was compatible for nearly all agents.
Why the study?
Although DOACs provide an effective treatment option for cancer-associated thrombosis, the need to assess drug-drug interactions with antineoplastic therapies poses a barrier in clinical practice.
What is the likelihood of drug-drug interactions between DOACs and antineoplastic agents in patients with cancer-associated venous thromboembolism?
What is the likelihood of drug-drug interactions between DOACs and antineoplastic agents in patients with cancer-associated venous thromboembolism?
This review provides a comprehensive guide on drug-drug interactions between DOACs and antineoplastic agents, demonstrating that despite a 12% interaction risk, at least one DOAC is compatible with nearly all cancer therapies for treating cancer-associated thrombosis.
Venous thromboembolism (VTE) is a frequent complication of cancer, and management of cancer-associated thrombosis (CAT) is challenging due to increased risks of bleeding and recurrent VTE. Recent trials have shown an acceptable efficacy and safety of direct oral anticoagulants (DOACs) in the treatment of CAT compared to low-molecular weight heparin. Although DOACs provide an effective and convenient treatment option in CAT, the need to assess the risk of drug-drug interactions (DDI) with antineoplastic therapies poses a barrier to their use in clinical practice. With the aim of supporting the assessment of CAT patients for treatment with DOAC, this review provides a comprehensive overview of the compatibility of antineoplastic therapies with the individual DOACs (apixaban, dabigatran, edoxaban, and rivaroxaban). Using several data sources, we characterized 100 widely used antineoplastic agents with regard to their effect on p-glycoprotein and cytochrome P450, both important in the transport and elimination of DOACs. This enabled us to evaluate 400 "DOAC-antineoplastic agent"-pairs regarding their likelihood to interact (unlikely, potential, or likely), ultimately leading to clinical recommendations on the appropriateness of concomitant use for each pair. A potential or likely DDI was identified for 12% of the evaluated pairs. For nearly all antineoplastic agents, at least one DOAC was considered compatible.
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Hellfritzsch et al. (2023) conducted a review in Cancer-associated venous thromboembolism. Direct oral anticoagulants (DOACs) and antineoplastic agents was evaluated on Likelihood of drug-drug interaction (unlikely, potential, or likely). A potential or likely drug-drug interaction was identified for 12% of the 400 evaluated DOAC-antineoplastic agent pairs, though at least one DOAC was compatible for nearly all agents.
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