Use of direct oral anticoagulants for treatment of atrial fibrillation in patients with HIV

West, T.; Perram, Jacinta; Holloway, Catherine

doi:10.1097/coh.0000000000000412

Cited by 11 publications

(12 citation statements)

References 22 publications

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“… 47 Other studies have shown that ritonavir-boosted protease inhibitors seem safe in patients taking dabigatran. 48 , 49 A recent review indicates that the concomitant use of protease inhibitors is contraindicated or not recommended with apixaban, rivaroxaban, and edoxaban but, in the case of dabigatran, although there are limited data, no significant interaction is expected. 50 Another recent review reported that no dose modification is required with the concomitant use of lopinavir/ritonavir and dabigatran, whereas a 50% dose reduction is necessary with apixaban and coadministration is not recommended for edoxaban and rivaroxaban.…”

Section: Oral Anticoagulation and Covid-19 Infectionmentioning

confidence: 99%

Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

Iturbe-Hernandez¹,

Romualdo²,

Ortega³

et al. 2020

DIC

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Atrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection. Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship. COVID-19 infection increases the risk of developing both arterial and venous thrombotic complications through systemic coagulation activation, leading to increased mortality. Chronic oral anticoagulation is essential to reduce the thromboembolic risk among AF patients. Switching to low-molecular-weight heparin has been recommended during hospitalization for COVID-19 infection. Of note, at discharge, the prescription of direct oral anticoagulants may offer some advantages over vitamin K antagonists. However, oral anticoagulants should only be prescribed after the consideration of drug–drug interactions with antiviral therapies as well as of the risk of hepatotoxicity, which is common among individuals with severe COVID-19 pneumonia. Not all anticoagulants have the same risk of hepatotoxicity; dabigatran has shown a good efficacy and safety profile and could have a lower risk of hepatotoxicity. Furthermore, its metabolism by cytochrome P450 is absent and it has a specific reversal agent. Therefore, dabigatran may be considered as a first-line choice for oral anticoagulation at discharge after COVID-19 infection. In this review, the available information on the antithrombotic management of AF patients at discharge after COVID-19 infection is updated. In addition, a practical algorithm, considering renal and liver function, which facilitates the anticoagulation choice at discharge is presented.

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Section: Oral Anticoagulation and Covid-19 Infectionmentioning

confidence: 99%

Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

Iturbe-Hernandez¹,

Romualdo²,

Ortega³

et al. 2020

DIC

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“…By the same mechanism, NOACs also have interaction with ART drugs . A case of decreased rivaroxaban concentration by concomitant nevirapine administration has been described, as the result of putative CYP3A induction and accelerated drug clearance .…”

Section: Managing Drug–drug Interactions In Patients With Hiv‐1 and Amentioning

confidence: 99%

Atrial fibrillation and human immunodeficiency virus type‐1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy

Pastori

Mezzaroma

Pignatelli

et al. 2019

Brit J Clinical Pharma

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The prevalence and incidence of atrial fibrillation/flutter (AF/AFL) in patients with human immunodeficiency virus type-1 (HIV-1) infection have been poorly investigated. We performed a systematic review using PubMed and Cochrane Database of Systematic Reviews, and screening of references, searching for clinical studies reporting on the association between HIV-1 infection and AF/AFL. We also summarized the main interactions of antiretroviral agents with antithrombotic and antiarrhythmic drugs. We found a prevalence of AF/AFL ranging from 2.0% to 5.13% in patients with HIV-1, with an incidence rate of 3.6/1000 personyears. Low CD4+ count (<200-250 cells ml À1 ) and high viral load were predictors of AF/AFL. Regarding drugs interactions, nucleoside reverse transcriptase inhibitors, integrase inhibitor and maraviroc have the lowest interactions with oral anticoagulants. Among anticoagulants, dabigatran presents the most favourable profile. Most of antiarrhythmic drugs interact with protease inhibitors, with beta blockers and diltiazem having fewer interactions. The few studies available suggest a non-negligible prevalence of AF/AFL in patients with HIV-1 infection. Awareness of potential interactions with anticoagulation and antiarrhythmic drugs is needed to offer optimal management in this population. CVD, even in treated HIV-1 patients [3]. Moreover, low CD4+ T cell count and/or failure to restore normal CD4+ T cell British Journal of Clinical PharmacologyBr J Clin Pharmacol (2019) 85 508-515 508

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“…Correspondence Two patients had bleeding complications with concomitant administration of the PI and one developed DVT whilst also on nevirapine. The authors comment on their own successful experience of using dabigatran for AF in more than 20 patients on ART (West et al, 2017). To our knowledge, use of apixaban and edoxaban has not been reported in patients with HIV and there are no reports of the use of DOACs for the treatment of VTE in this patient population.…”

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confidence: 99%

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

et al. 2019

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Use of direct oral anticoagulants for treatment of atrial fibrillation in patients with HIV

Abstract: Caution is needed when prescribing DOACs in patients with atrial fibrillation and HIV due to potential drug interactions. Studies are lacking and current advice is based on case reports, expert opinion and knowledge of theoretical interactions.

Cited by 11 publications

References 22 publications

Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

Atrial fibrillation and human immunodeficiency virus type‐1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy

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

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