Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding

Delaney, Joseph A.; Opatrny, Lucie; Brophy, James M.; Suissa, Samy

doi:10.1503/cmaj.070186

Cited by 207 publications

(177 citation statements)

References 18 publications

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“…Clopidogrel is not mentioned in a literature review of interactions occurring with warfarin [34], but prescribing information provided by Swiss manufacturers clearly states that when prescribed with a VKA, clopidogrel may be associated with a significant increased risk of bleeding [50]. In addition, the association of clopidogrel, aspirin and warfarin significantly increase the risk of gastrointestinal bleeding [51]. In a recent study, the risk of bleeding was significantly increased when clopidogrel was coprescribed with warfarin [adjusted relative risk (AdjRR) 2.23, 95 % CI 1.…”

Section: Discussionmentioning

confidence: 99%

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Gschwind

Rollason

Lovis

et al. 2012

Eur J Clin Pharmacol

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Purpose The objective of this study was to identify the most clinically relevant drug-drug interactions (DDIs) at risk of affecting acenocoumarol safety in our tertiary care university hospital, a 2,000 bed institution. Methods We identified DDIs occurring with acenocoumarol by combining two different sources of information: a 1-year retrospective analysis of acenocoumarol prescriptions and comedications from our Computerized Physician Order Entry (CPOE) system (n = 2,439 hospitalizations) and a retrospective study of clinical pharmacology consultations involving acenocoumarol over the past 14 years (1994-2007) (n = 407). We classified these DDIs using an original risk-analysis method. A criticality index was calculated for each associated drug by multiplying three scores based on mechanism of interaction, involvement in a supratherapeutic international normalized ratio (INR) (≥ 6) and involvement in a severe bleeding.Results One hundred and twenty-six DDIs were identified and weighted. Twenty-eight drugs had a criticality index ≥ 20 and were therefore considered at high risk for interacting with acenocoumarol by increasing its effect: 75% of these drugs involved a pharmacokinetic mechanism and 14 % a pharmacodynamic mechanism. An unknown mechanism of interaction was involved in 11 % of drugs. Conclusion Twenty-eight specific drugs were identified as being at high risk for interacting with acenocoumarol in our hospital using an original risk-analysis method. Most analyzed drugs interact with acenocoumarol via a pharmacokinetic mechanism. Actions such as the implementation of alerts in our CPOE system should be specifically developed for these drugs.

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Section: Discussionmentioning

confidence: 99%

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Gschwind

Rollason

Lovis

et al. 2012

Eur J Clin Pharmacol

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“…22 A second similarly designed study reported adjusted hazard ratios of 1.67, 1.39, and 3.90, for clopidogrel, aspirin, and their combination, respectively. 23 In terms of absolute numbers, a study including 4 major combination therapy trials yielded an aggregate rate of severe bleeds of 1.8%. 24 A review of those trials also yields additional minor bleeding with a range of 2.1% to 5.3%.…”

Section: Bleeding Risks With Combination Therapymentioning

confidence: 99%

An Appraisal of Dual Antiplatelet Therapy with Clopidogrel and Aspirin for Prevention of Cardiovascular Events

Terpening¹

2009

The Journal of the American Board of Family Medicine

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Combination antiplatelet therapy, typically with clopidogrel and aspirin, is commonly used for the prevention of cardiovascular events. When used for appropriate indications and duration, its benefits clearly outweigh its risks. However, it is not uncommon for the combination to be used outside of recommended indications or for longer than recommended durations. In these circumstances data are at best unclear and, at worst, indicative of harm. Furthermore, use for one of its indications-prevention of cardiac events after deployment of a coronary stent-is complicated by the type of stent used. This report reviews the evidence surrounding combination antiplatelet therapy with clopidogrel and aspirin, with an emphasis on identifying appropriate indications for and durations of therapy. (

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“…Por esse motivo, na medicina opta-se sempre pela utilização de um agente antitrombótico para o tratamento e prevenção de doenças tromboembólicas venosas, deixando de lado a terapia antiplaquetária. A associação de anticoagulantes e antiagregantes plaquetários para o tratamento de tromboses venosas em humanos não é indicada devido ao alto risco de sangramentos, principalmente de origem gastrointestinal [42]. Em eqüinos utiliza-se esta associação para o tratamento da laminite, não sendo relatada a ocorrência de hemorragias [25].…”

Section: Antiagregantes Plaquetáriosunclassified

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

Borghesan¹

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Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding

Cited by 207 publications

References 18 publications

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

An Appraisal of Dual Antiplatelet Therapy with Clopidogrel and Aspirin for Prevention of Cardiovascular Events

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

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