Direct oral anticoagulants for the management of venous thromboembolism in patients with HIV – a single centre experience

Oliveira, Ricardo; Patel, Raj; Taylor, Chris; Czuprynska, Julia; Arya, Roopen; Roberts, Lara N.

doi:10.1111/bjh.15986

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…24 The majority of patients received NNRTI-based ART (n = 6), followed by INSTI (n = 3), PI (n = 2), or no HIV treatment (n = 1). 25 Other publications on the coadministration of DOACs in PLWH on ART include three case reports, two with dabigatran (and PI-based ART) and one with rivaroxaban (and NNRTI-based ART). 26,27,24,28 Further case series have highlighted drug interactions.…”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants versus warfarin in people living with human immunodeficiency virus

et al. 2021

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Human immunodeficiency virus (HIV) is associated with increased rates of cardiovascular disease and vascular events, and people living with HIV (PLWH) may often have indications for therapeutic anticoagulation. However, the ideal anticoagulant in PLWH remains unknown. This retrospective cohort evaluated the tolerability and effectiveness of oral anticoagulants in PLWH. The primary outcome was tolerability, defined as a composite of bleeding and/or discontinuation rates. The secondary outcomes included recurrent thromboembolism, bleeding, and discontinuations, independently. There were 92 patients included for analysis, 48 in the direct oral anticoagulant (DOAC) arm and 44 in the warfarin arm. There were 35 (38%) PLWH that did not tolerate oral anticoagulation therapy in the total cohort. Among these, 19 received a DOAC and 16 received warfarin. There were 16 (17%) PLWH that experienced a bleeding event: six in the DOAC arm and 10 in the warfarin arm. There were 15 (16%) PLWH that experienced recurrent thromboembolism, with similar rates between DOAC versus warfarin (10, 21% vs 5, 11%, respectively; p = 0.11). The most commonly prescribed HIV regimens were protease inhibitor and integrase inhibitor-based regimens. Overall, anticoagulation-related outcomes with either a DOAC or warfarin were poor in our cohort of PLWH, with high rates of bleeding, discontinuations, and recurrent thromboembolism. Further studies are necessary to validate and assess reasons for poor tolerability.

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Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants versus warfarin in people living with human immunodeficiency virus

et al. 2021

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“…Oliveira et al 134 reported that DOACs is more efficient than conventional anticoagulant. CYP3A4 along with P‐glycoprotein transporter (P‐GP) can metabolize DOACs 114 …”

Section: Managementmentioning

confidence: 99%

Venous thromboembolism in viral diseases: A comprehensive literature review

Zerangian

Erabi

Poudineh

et al. 2023

Health Science Reports

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Venous thromboembolism (VTE) is known to be a common respiratory and/or cardiovascular complication in hospitalized patients with viral infections. Numerous studies have proven human immunodeficiency virus infection to be a prothrombotic condition. An elevated VTE risk has been observed in critically ill H1N1 influenza patients. VTE risk is remarkably higher in patients infected with the Hepatitis C virus in contrast to uninfected subjects. The elevation of D‐dimer levels supported the association between Chikungunya and the Zika virus and the rise of clinical VTE risk. Varicella‐zoster virus is a risk factor for both cellulitis and the consequent invasive bacterial disease which may take part in thrombotic initiation. Eventually, hospitalized patients infected with the coronavirus disease of 2019 (COVID‐19), the cause of the ongoing worldwide pandemic, could mainly suffer from an anomalous risk of coagulation activation with enhanced venous thrombosis events and poor quality clinical course. Although the risk of VTE in nonhospitalized COVID‐19 patients is not known yet, there are a large number of guidelines and studies on thromboprophylaxis administration for COVID‐19 cases. This study aims to take a detailed look at the effect of viral diseases on VTE, the epidemiology of VTE in viral diseases, and the diagnosis and treatment of VTE.

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“…6,7,10,11 Furthermore, there is a paucity of clinical outcomes data with DOAC use in this population. 7,12-15 In some cases, providers or patients may prefer a DOAC instead of warfarin due to fewer monitoring requirements for treatment and increased adherence. 4,5…”

Section: Introductionmentioning

confidence: 99%

“…6,7,10,11 Furthermore, there is a paucity of clinical outcomes data with DOAC use in this population. 7,[12][13][14][15] In some cases, providers or patients may prefer a DOAC instead of warfarin due to fewer monitoring requirements for treatment and increased adherence. 4,5 This study aimed to describe characteristics of this highrisk patient population, prescribing patterns observed, therapy modifications employed, and general outcomes associated with concurrent DOAC and interacting ARV treatment.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Direct Oral Anticoagulant Therapy With Concomitant Use of Interacting Antiretroviral Agents

Brazeale

Fuentes

Adeola

2021

Journal of Pharmacy Practice

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Background: A theoretical interaction exists between human immunodeficiency virus (HIV) antiretroviral (ARV) agents and direct oral anticoagulants (DOACs), although the clinical significance is unclear. Objective: This study aimed to assess characteristics, prescribing patterns, and outcomes associated with concomitant therapy. Methods: A single-center, retrospective review was performed on patients older than 18 years prescribed a DOAC for any indication with concurrent interacting ARV(s) from June 2016 through June 2019. The primary endpoint was to assess prescribing and population characteristics. Secondary endpoints were to evaluate safety outcomes, DOAC level monitoring, readmissions, outpatient follow-up, and DOAC modification interventions. Results: Thirty-six patients (72 hospital admissions) were identified. The most common DOAC was apixaban (83.3%) and ARV was ritonavir (50%). Of the 72 encounters, 26 (36.1%) DOACs were dosed appropriately per guideline recommendations. Twenty pharmacy interventions for therapy modification were recognized. Eleven (30.6%) patients experienced bleeding and 2 (5.6%) thrombosis. Of the adverse events, all patients had renal impairment. Conclusions: As DOAC utilization grows, increasing use in HIV could be expected. More frequent adjustment or avoidance is recommended per guidelines. Our data suggest the majority of patients receive CYP3A4-inhibiting regimens. Caution should be employed with renal insufficiencies. Further studies are warranted to assess safety and efficacy within this population.

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Direct oral anticoagulants for the management of venous thromboembolism in patients with HIV – a single centre experience

Cited by 7 publications

References 9 publications

Direct oral anticoagulants versus warfarin in people living with human immunodeficiency virus

Direct oral anticoagulants versus warfarin in people living with human immunodeficiency virus

Venous thromboembolism in viral diseases: A comprehensive literature review

Analysis of Direct Oral Anticoagulant Therapy With Concomitant Use of Interacting Antiretroviral Agents

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