ArticleJournal of thrombosis and thrombolysis2020
The real world use of combined P-glycoprotein and moderate CYP3A4 inhibitors with rivaroxaban or apixaban increases bleeding.
Article in Journal of thrombosis and thrombolysis, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 3 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Pooled it
- Rivaroxaban Pharmacokinetics in Obese Subjects: A Systematic Review.Clinical pharmacokinetics · 2022Pooled it
- Population Pharmacokinetic Models for Direct Oral Anticoagulants: A Systematic Review and Clinical Appraisal Using Exposure Simulation.Clinical pharmacology and therapeutics · 2022Pooled it
- Clinical decision support tool evaluation: Correction of direct oral anticoagulant dosing errors by clinical pharmacists and physicians.Research and practice in thrombosis and haemostasis · 2026Trial
- Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.Implementation science : IS · 2023Trial
- Application of a Modified In Situ Perfusion Model to Quantify Intestinal Drug Excretion and Transporter-Mediated Interactions after Intravenous Administration.The AAPS journal · 2026Article
- Real-World Impact of Amiodarone on Apixaban Population Pharmacokinetics in Hospitalized Patients.Clinical and translational science · 2025Article
- Recommendations for hypolipidemic and antithrombotic therapy in HCV-infected patients treated with direct-acting antiviral agents: expert position statement.Clinical and experimental hepatology · 2025Review
- Clinical Challenges in Treating Cancer-Associated Thrombosis: A Clinically Oriented Review.Acta haematologica · 2025Review
- Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism.Frontiers in oncology · 2025Article
- Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review.Diseases (Basel, Switzerland) · 2024Article
- Letter to the editor regarding the paper by A. Boileve et al.: Safety of direct oral anticoagulants in patients with advanced solid tumors receiving anti‑VEGF agents: a retrospective study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- Co-Administration of Amiodarone Increases Bleeding by Affecting Rivaroxaban Pharmacokinetics in Patients with Atrial Fibrillation.Pharmaceutics · 2024Article
- Pharmacokinetics and pharmacodynamics of drug‒drug interactions in hospitalized older adults treated with direct oral anticoagulants.Aging clinical and experimental research · 2024Article
- Pharmacokinetic drug-drug interaction between olaparib and apixaban: a case report.Cancer chemotherapy and pharmacology · 2024Article
- Risk scores for major bleeding from direct oral anticoagulants: comparing predictive performance in patients with atrial fibrillation.Research and practice in thrombosis and haemostasis · 2024Article
- Observational
- Drug-drug interactions with oral anticoagulants: information consistency assessment of three commonly used online drug interactions databases in Switzerland.Frontiers in pharmacology · 2024Article
- Effectiveness and Safety of Different Oral Anticoagulants with P-glycoprotein/ CYP3A4 Inhibitors: A Network Meta-analysis.Current pharmaceutical design · 2024Article
- Prevalence and factors associated with inappropriate dosing of apixaban and rivaroxaban in hospitalized older adults with atrial fibrillation: a cross-sectional study.Drugs & aging · 2024Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The use of direct oral anticoagulants for stroke prevention in atrial fibrillation continues to rise. Certain populations may be at higher risk for increased drug exposure and adverse events. Pharmacokinetic studies suggest increased exposure of rivaroxaban and apixaban with combined P-gp and moderate CYP3A4 inhibitors but the clinical relevance of this is unknown. This retrospective cohort study included patients receiving rivaroxaban or apixaban from January 1, 2012 to December 31, 2016 with a moderate inhibitor (amiodarone, dronedarone, diltiazem, verapamil) for at least 3 months in the drug-drug interaction (DDI) group. Propensity matching was used to identify similar control patients without the presence of the DDI. The primary outcome was a time to event analysis of any bleeding episode as defined by the International Society of Thrombosis and Hemostasis. After propensity matching, 213 patients with similar baseline characteristics were included in each group. The mean CHA2DS2-VASc score was 3.0 and median duration of follow-up was 1.45 years. The primary outcome occurred in 26.4% of patients in the DDI group and 18.4% in the control group (hazard ratio 1.8, 95% confidence interval [CI] 1.19 to 2.73; p-value = 0.006). There was no difference in bleeding rates based on type of inhibitor. Use of a combined P-gp and moderate CYP3A4 inhibitor with rivaroxaban or apixaban increased bleeding risk compared to patients without the DDI in this real world, retrospective study. Analysis in a larger patient population is needed to confirm these findings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.