Old and new oral anticoagulants: Food, herbal medicines and drug interactions. Issue 4 (July 2017)

• Record Type: Journal Article
• Authors: Di Minno, Alessandro; Frigerio, Beatrice; Spadarella, Gaia; Ravani, Alessio; Sansaro, Daniela; Amato, Mauro; Kitzmiller, Joseph P.; Pepi, Mauro; Tremoli, Elena; Baldassarre, Damiano
• Is Part Of: Blood reviews. Volume 31:Issue 4(2017:Jul.)
• Page Start: 193
• Page End: 203
• Publication Date: 2017-07
• Subjects: Warfarin -- Direct anticoagulant drugs -- Loss of efficacy -- Toxicity -- Thrombotic/bleeding events -- Therapeutic context -- Patients characteristics -- Co-morbidities; Hematology -- Periodicals; Hematology -- Periodicals; Hématologie -- Périodiques; Hematology; Electronic journals; Periodicals; 616.15
• DOI: 10.1016/j.blre.2017.02.001
• Languages: English
• ISSNs: 0268-960X

Abstract

Abstract: 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.