Drug-drug interaction between warfarin and statins: A Danish cohort study

Engell, Anna; Svendsen, Andreas Ludvig Ohm; Lind, Bent; Andersen, Christen Lykkegaard; Andersen, John; Willadsen, Tora; Persson, Frederik; Pottegård, Anton

doi:10.22541/au.158705375.56332460

Cited by 3 publications

(5 citation statements)

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“…The primary strength of this study is the large number of available, consecutive INR measurements from a real-world clinical setting (6). The principal limitation of the study is the lack of clinical outcome data.…”

Section: Discussionmentioning

confidence: 99%

“…We identified a cohort of adult (≥18 years) warfarin users from Denmark from 2000-2015. Patients with ≥2 INR measurements recorded in the Copenhagen Primary Care Laboratory (CopLab) database were included as previously described (6). Within this cohort, we obtained data from the Danish National Prescription Registry (7) on incident outpatient prescription fills on the antimycotics used in oral candidiasis in Denmark, that is systemic fluconazole (ATC-code J02AC01), miconazole oral gel (A01AB09) and nystatin oral solution (A07AA02).…”

Section: Study Populationmentioning

confidence: 99%

See 1 more Smart Citation

Antimycotic Treatment of Oral Candidiasis in Warfarin Users

Iversen

Hellfritzsch

Stage

et al. 2021

The American Journal of Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Antimycotic Treatment of Oral Candidiasis in Warfarin Users

Iversen

Hellfritzsch

Stage

et al. 2021

The American Journal of Medicine

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“…The authors of this study recommended close monitoring after initiation of these statins, as patients with certain CYP450 genotypes may be more vulnerable. 49,55…”

Section: Vitamin K Antagonist: Warfarinmentioning

confidence: 99%

“…49–54 An analysis of a large national database registry demonstrated that atorvastatin, rosuvastatin, and simvastatin all increased the mean INR by ≈ 0.3, with a peak at around 4 weeks. 55 This degree of INR elevation was not thought to be clinically significant to warrant a preemptive dose reduction of warfarin. The authors of this study recommended close monitoring after initiation of these statins, as patients with certain CYP450 genotypes may be more vulnerable.…”

Section: Vitamin K Antagonist: Warfarinmentioning

confidence: 99%

Drug Interactions Affecting Oral Anticoagulant Use

Mar

Gopinathannair

Gengler

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Oral anticoagulants (OACs) are medications commonly used in patients with atrial fibrillation and other cardiovascular conditions. Both warfarin and direct oral anticoagulants are susceptible to drug-drug interactions (DDIs). DDIs are an important cause of adverse drug reactions and exact a large toll on the health care system. DDI for warfarin mainly involve moderate to strong inhibitors/inducers of cytochrome P450 (CYP) 2C9, which is responsible for the elimination of the more potent S-isomer of warfarin. However, inhibitor/inducers of CYP3A4 and CYP1A2 may also cause DDI with warfarin. Recognition of these precipitating agents along with increased frequency of monitoring when these agents are initiated or discontinued will minimize the impact of warfarin DDI. Direct oral anticoagulants are mainly affected by medications strongly affecting the permeability glycoprotein (P-gp), and to a lesser extent, strong CYP3A4 inhibitors/inducers. Dabigatran and edoxaban are affected by P-gp modulation. Strong inducers of CYP3A4 or P-gp should be avoided in all patients taking direct oral anticoagulant unless previously proven to be otherwise safe. Simultaneous strong CYP3A4 and P-gp inhibitors should be avoided in patients taking apixaban and rivaroxaban. Concomitant antiplatelet/anticoagulant use confers additive risk for bleeding, but their combination is unavoidable in many cases. Minimizing duration of concomitant anticoagulant/antiplatelet therapy as indicated by evidence-based clinical guidelines is the best way to reduce the risk of bleeding.

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“…O estudo demonstrou que a presença da sinvastatina foi capaz de deslocar a ligação da proteína plasmática da S-varfarina e que a inibição da CYP causa significativa interação entre estes medicamentos. Outros estudos observaram pequena alteração na RNI na presença de estatinas, portanto consideram a interação de limitada relevância clínica, mas concluem que, considerando a estreita faixa terapêutica da varfarina, o tratamento concomitante deve ser acompanhado por um monitoramento mais frequente (ENGELL et al, 2020;ANDERSSON;MANNHEIMER;LINDH, 2019).…”

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Estudo Observacional Com Pacientes Hospitalizados Em Tratamento Com Varfarina

Nutti¹,

Fernandes²

2022

Publ. Biologicas

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A varfarina é um anticoagulante oral de ampla utilização, com diversas indicações na prática clínica. Entretanto, apresenta diversos inconvenientes que podem interferir no sucesso terapêutico, como por exemplo, a estreita faixa terapêutica, variabilidade na relação dose-resposta, extensa interação com medicamentos e alimentos, necessidade de controle laboratorial periódico e ajustes de dose frequentes. O objetivo deste trabalho foi identificar os potenciais interferentes na resposta à terapia anticoagulante oral com varfarina, bem como elaborar um protocolo de acompanhamento farmacoterapêutico. O estudo observacional prospectivo foi realizado em um único centro, com grupo único de indivíduos, em hospital público geral. O recrutamento de pacientes ocorreu entre março e junho de 2021, com inclusão de pacientes que atenderam aos critérios de inclusão e aceitaram participar do estudo. Os desfechos analisados foram tempo de permanência hospitalar, tempo até razão normalizada internacional (RNI) alvo, manejo de doses e alta com RNI em faixa alvo, número de medicamentos e presença de potenciais interações medicamentosas. O tempo médio para atingir RNI alvo foi de 4,5 dias. Durante a internação 69,2% dos pacientes observados atingiram RNI alvo, entretanto apenas 50% tiveram alta com valores na faixa alvo para a indicação. A média de comorbidades por indivíduo foi de 4,38, e média de 9,4 medicamentos prescritos por paciente, com 4,8 potenciais interações medicamentosas por paciente. Os resultados observados apontam diversas oportunidades para a atuação do farmacêutico no cuidado a este paciente, de forma a contribuir para a qualidade e segurança deste tratamento.

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Drug-drug interaction between warfarin and statins: A Danish cohort study

Cited by 3 publications

References 0 publications

Antimycotic Treatment of Oral Candidiasis in Warfarin Users

Antimycotic Treatment of Oral Candidiasis in Warfarin Users

Drug Interactions Affecting Oral Anticoagulant Use

Estudo Observacional Com Pacientes Hospitalizados Em Tratamento Com Varfarina

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