Non-vitamin K Antagonist Oral Anticoagulants and Drug-Food Interactions: Implications for Clinical Practice and Potential Role of Probiotics and Prebiotics

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) are a therapeutic option to prevent stroke in patients with atrial fibrillation (AF). In fact, NOACs have become the recommended choice by international clinical practice guidelines over vitamin K antagonists (VKA), because of their efficacy and safety profile, especially in newly initiated patients. The more predictable pharmacokinetic and pharmacodynamic profile of this family of drugs allows preventing anticoagulation drug monitoring. Furthermore, NOACs have significantly fewer drug and food interactions in comparison with VKAs. Despite this, there are no studies that compare the effects on the quality of anticoagulation of NOACs with the intake of potential interactions drugs of P-glycoprotein and cytochrome P450 (CYP). This review brings an overview of NOACs pharmacokinetics profile and their potential drug-food interactions. We also briefly discuss the potential role of prebiotics and probiotics in patients under therapy with NOACs.

Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation

“…Sánchez-Fuentes et al ( 107 ) recently described the potential effects of herbal medicines, dietary supplements, and foods highlighting their potential interactions with DOACs. The findings of their interesting research ( 107 ) can be applied in clinical practice even in these patients who are certainly more complex in consideration of their clinical history. In addition, due to the growing interest in herbal products, probiotics, and prebiotics, and their widespread use, concomitant use with DOACs is likely to occur.…”

Impact of Selective Serotonin-Reuptake Inhibitors in Hemorrhagic Risk in Anticoagulated Patients Taking Non–Vitamin K Antagonist Anticoagulants

“…These antidepressant medications differ in CYP450 inhibition and in potency as SRIs, which affects potency at influencing platelet aggregation 16 . Although NOACs present a more predictable pharmacokinetic and pharmacodynamic profile and have fewer food and drug interactions in comparison with VKAs, 17 monitoring of drug interaction should not be neglected.…”

“…These antidepressant medications differ in CYP450 inhibition and in potency as SRIs, which affects potency at influencing platelet aggregation. 16 Although NOACs present a more predictable pharmacokinetic and pharmacodynamic profile and have fewer food and drug interactions in comparison with VKAs, 17 monitoring of drug interaction should not be neglected. Finally, available evidence supports that SSRIs are associated with a higher risk of major bleeding in patients taking NOACs; however, our confidence is reduced because of nonstatistically significant results from more robust studies, as cohort studies.…”

Vitamin K and age-related diseases

“…Другими заметными источниками K2 являются куриное мясо, яичные желтки, квашеная капуста, говядина и лосось [10]. В последнее время появляется все больше данных о способности кишечных бактерий самостоятельно синтезировать витамин К [13].…”