Use of non-vitamin K oral anticoagulants with certain medications are associated with an increased risk of major bleeding, according to a study published by JAMA.
Oral anticoagulation has been proven to prevent ischemic strokes and prolong life for patients with atrial fibrillation. Non-vitamin K oral anticoagulants (NOACs) are being used more frequently because of their ease of administration and comparative efficacy compared with warfarin in reducing blood clots and major bleeding.
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‘Physicians prescribing non-vitamin K oral anticoagulants (NOACs) medications should consider the potential risks associated with concomitant use of other drugs.’
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However, for patients with atrial fibrillation, NOACs are often prescribed with other medications that share metabolic pathways that may increase major bleeding risk.
Chang-Fu Kuo, M.D., Ph.D., of Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues used data from the Taiwan National Health Insurance database and included 91,330 patients with nonvalvular atrial fibrillation who received at least one NOAC prescription of dabigatran, rivaroxaban, or apixaban and estimated the bleeding risk associated with or without the concurrent use of 12 commonly prescribed medications that share metabolic pathways with NOACs (atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin).
![Delayed Use of Blood Thinners for Patients With Atrial Fibrillation Increases Dementia Risk]( "Delayed Use of Blood Thinners for Patients With Atrial Fibrillation Increases Dementia Risk")
The risk of dementia in low-risk patients was 30% higher for those who received delayed treatment, and a significant 136% higher for high-risk patients.
Among the patients in the study, 4,770 major bleeding events occurred. The researchers found that concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in incidence rates of major bleeding than NOACs alone.
Compared with NOAC use alone, the incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone.
The study notes some limitations, including that bleeding risk and anticoagulant treatment in the Asian population have been recognized to be different from the Western population. Therefore, the external generalizability of these results, particularly to a Western population may be limited.
"Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs," the authors write.
Source: Eurekalert
Delayed Use of Blood Thinners for Patients With Atrial Fibrillation Increases Dementia Risk
The risk of dementia in low-risk patients was 30% higher for those who received delayed treatment, and a significant 136% higher for high-risk patients.
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Among the patients in the study, 4,770 major bleeding events occurred. The researchers found that concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in incidence rates of major bleeding than NOACs alone.
Compared with NOAC use alone, the incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone.
The study notes some limitations, including that bleeding risk and anticoagulant treatment in the Asian population have been recognized to be different from the Western population. Therefore, the external generalizability of these results, particularly to a Western population may be limited.
"Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs," the authors write.
Source: Eurekalert
As-Needed Basis Blood Thinners Lower Stroke Risk Than Long-Term Use
Oral anticoagulation therapy is recommended in patients with infrequent atrial fibrillation and high risk of stroke.
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 New Type Of Blood Thinner More Effective In Preventing StrokeDirect oral anticoagulant are blood thinning medicines which can reduce the risk of stroke in patients who have irregular heart beat. | Advertisement
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