Author + information
- Received October 27, 2019
- Revision received December 18, 2019
- Accepted December 23, 2019
- Published online March 16, 2020.
- Barbara S. Wiggins, PharmDa,∗ (, )@MUSChealth,
- Dave L. Dixon, PharmDb,
- Ron R. Neyens, PharmDa,
- Robert L. Page II, PharmD, MSPHc and
- Ty J. Gluckman, MDd
- aDepartment of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina
- bDepartment of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
- cDepartment of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, Aurora, Colorado
- dCenter for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon
- ↵∗Address for correspondence:
Dr. Barbara S. Wiggins, Clinical Pharmacy Specialist- Cardiology, Medical University of South Carolina, South Carolina College of Pharmacy, 150 Ashley Avenue, PO Box 250584, Charleston, South Carolina 29466.
• Drug-drug interactions with the DOACs can lead to serious adverse events.
• A thorough review of the literature was performed to evaluate for select interactions.
• Specific recommendations on ensuring safety and efficacy are outlined.
• Primary attention is given to clinical management.
Millions of individuals in the United States require long-term treatment with an oral anticoagulant. For decades, vitamin K antagonists were the only oral option available; however, they have a number of well-known limitations. Introduction of the direct oral anticoagulants (DOACs) has long been considered a major therapeutic advance, largely because they lack the need for therapeutic monitoring. Despite this, DOACs, like vitamin K antagonists, can still cause major and clinically relevant nonmajor bleeding, even when used appropriately. Drug-drug interactions (DDIs) involving the DOACs represent an important contributor to increased bleeding risk. Awareness of these DDIs and how best to address them is of critical importance in optimizing management while mitigating bleeding risk. This review provides an overview of DOAC metabolism, the most common drugs likely to contribute to DOAC DDIs, their underlying mechanisms, and how best to address them.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 27, 2019.
- Revision received December 18, 2019.
- Accepted December 23, 2019.
- 2020 American College of Cardiology Foundation
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