ArticleEuropean journal of clinical pharmacology2021
Bleeding and thromboembolism due to drug-drug interactions with non-vitamin K antagonist oral anticoagulants-a Swedish, register-based cohort study in atrial fibrillation outpatients.
Article in European journal of clinical pharmacology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Risk factors for anticoagulant-associated gastrointestinal hemorrhage: a systematic review and meta-analysis.The Korean journal of internal medicine · 2024Pooled it
- Drug-drug interactions with direct oral anticoagulants: development of a consensus list for ambulatory care.International journal of clinical pharmacy · 2023Guideline
- Effect of Clarithromycin, a Strong CYP3A and P-glycoprotein Inhibitor, on the Pharmacokinetics of Edoxaban in Healthy Volunteers and the Evaluation of the Drug Interaction with Other Oral Factor Xa Inhibitors by a Microdose Cocktail Approach.Cardiovascular drugs and therapy · 2024Trial
- Drug-drug interactions of NOACs with comedication: Prevalence and implications for adverse events in patients with atrial fibrillation.Heart rhythm O2 · 2026Article
- Decoding the causes of ischemic stroke despite ongoing oral anticoagulation and their clinical impact: the ASPERA-R study.Journal of neurology · 2026Article
- Potentially Clinically Significant Drug-Drug Interactions in Older Adults with Atrial Fibrillation and Multimorbidity: Prevalence, Correlates, and Association with Adverse Clinical Outcomes in a Swedish National Register-Based Study.Cardiovascular drugs and therapy · 2026Article
- Comparative bleeding risk between angiotensin II receptor blockers with high versus low P-glycoprotein inhibitory activity in patients with atrial fibrillation receiving direct oral anticoagulants.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Drug-drug interactions with direct oral anticoagulants in Belgian primary care patients with non-valvular atrial fibrillation.Scientific reports · 2026Article
- Trends in drug-drug interaction prevalence and longitudinal associations with health outcomes in the older community-dwelling population: Findings from The Irish LongituDinal study on Ageing.British journal of clinical pharmacology · 2025Article
- Tailoring Anticoagulant Therapy: Managing Interactions Between Carbamazepine and Direct Oral Anticoagulants (DOACs).Cureus · 2025Article
- Concomitant Drug Interactions With Non-Vitamin K Oral Anticoagulants Are Associated With Bleeding and Mortality Risk in Patients With Nonvalvular Atrial Fibrillation.Journal of the American Heart Association · 2025Article
- Analysis of Postoperative Bleeding After Oral Surgery in Patients Receiving Anticoagulants: A Retrospective Study.Medicina (Kaunas, Lithuania) · 2025Article
- Pharmacodynamic Drug-Drug Interactions and Bleeding Outcomes in Patients with Atrial Fibrillation Using Non-Vitamin K Antagonist Oral Anticoagulants: a Nationwide Cohort Study.Cardiovascular drugs and therapy · 2025Article
- Bibliometric Analysis of Non-Vitamin K Antagonist Oral Anticoagulants (NOACS) in the Prevention of Venous Thrombosis and Pulmonary Embolism.Drug design, development and therapy · 2025Review
- Research progress on bleeding risk assessment models in anticoagulant therapy.Frontiers in cardiovascular medicine · 2025Review
- Effect of the frequently used antiepileptic drugs carbamazepine, gabapentin, and pregabalin on the pharmacokinetics of edoxaban and other oral factor xa inhibitors in healthy volunteers.Frontiers in pharmacology · 2025Article
- The Impact of Polypharmacy on the Effectiveness and Safety of Non-vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation.Thrombosis and haemostasis · 2024Article
- 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
- Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation.BMC cardiovascular disorders · 2023Article
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
purposeTo study the association between interacting drugs and bleeding or thromboembolism in atrial fibrillation outpatients treated with non-vitamin K antagonist oral anticoagulants (NOACs).
methodsPopulation-based cohort study of outpatients treated with NOACs in Sweden from 2008 to 2017. Patients with atrial fibrillation and newly initiated NOAC treatment were identified in the Prescribed Drug Register. Comorbidities and outcome data were retrieved from the Patient Register and the Cause of Death Register. Cox-regression analyses were performed to evaluate the primary endpoints any severe bleed and ischemic stroke/transient ischemic attack/stroke unspecified during the first six months of treatment. Secondary endpoints were gastrointestinal bleeding, intracranial bleeding, ischemic stroke, and venous thromboembolism.
resultsIncreased risk of any severe bleed was found when NOAC treatment, and drugs with pharmacodynamic effect on bleeding were combined, compared to NOAC only. An increased risk with these combinations was evident for apixaban (hazard ratio (HR) 1.47; 95% CI 1.33-1.63), rivaroxaban (HR 1.7; 95% CI 1.49-1.92), and dabigatran (HR 1.26; 95% CI 1.05-1.52). For apixaban, there was an increased risk of any severe bleed when combined with CYP3A4 and/or P-glycoprotein (P-gp) inhibitors (HR 1.23; 95% CI 1.01-1.5). The use of inducers of CYP3A4 and/or P-gp was low in this cohort, and effects on ischemic stroke/TIA/stroke unspecified could not be established.
conclusionIncreased risk of bleeding was seen for pharmacodynamic and pharmacokinetic interactions with NOACs. Prescribers need to be vigilant of the effect of interacting drugs on the risk profile of patients treated with NOACs.
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