- Dabigatran is an oral anticoagulant prescribed in atrial fibrillation (AF) patients to reduce risk of stroke, with similar efficacy to warfarin, another popular oral anticoagulant.
- Dabigatran is preferred over warfarin since it carries lesser risk of major life threatening bleeds when compared to warfarin.
- Simvastatin and Lovastatin are two commonly used ‘statins’ to reduce levels of LDL or bad cholesterol and triglycerides.
- Recent studies have shown that the risk of hemorrhage is much higher if either Simvastatin or Lovastatin, is given to patients taking dabigatran.
Two commonly prescribed 'statins', Simvastatin and Lovastatin , used to lower levels of LDL cholesterol and triglycerides for prevention of heart disease, have been shown to cause increased incidence of bleeding when given to patients on dabigatran , a drug prescribed to prevent stroke in atrial fibrillation patients, according to a recent study in Ontario, Canada.
Aim of the Study
Atrial fibrillation and high lipid levels are both independently associated with a higher risk of stroke and heart disease, and can occur in the same patient. Consequently dabigatran and statins might be prescribed together for treatment.
Interestingly, studies conducted earlier have detected significant drug-drug interactions between warfarin (another oral anticoagulant) and statins, potentiating the anticoagulant effect of warfarin.
Details and Findings of the Study
Two separate studies were conducted on the residents of Ontario, aged 65 years and above who were started on dabigatran between 2012 and 2014, and involved a total of 45,991 patients. The findings of the study were as follows
- 397 patients suffered a stroke and 1117 persons had a major hemorrhage.
- The risk of bleeding increased by over 40 percent in patients who also took Simvastatin or Lovastatin, in comparison to those who were on other statins. "An increase in the risk of bleeding requiring hospital admission or emergency department visits was seen with lovastatin and simvastatin compared with the other statins," Dr. Antoniou said.
- The stroke risk of both Simvastatin and Lovastatin was similar in patients taking dabigatran.
Possible Mechanism of Interaction Between Statins and Dabigatran
Simvastatin and Lovastatin are thought to enhance dabigatran absorption by the body, causing increased blood levels, potentiating its anticoagulant effect and increasing risk of hemorrhage. This effect is not observed with other statins such as Atorvastatin .
Lessons from the Study
The findings of the study indicate that a potentially harmful and clinically significant drug interaction occurs between dabigatran and Simvastatin/Lovastatin. In patients with atrial fibrillation on dabigatran, alternative statins such as Atorvastatin should be considered instead of Simvastatin or Lovastatin.