Format

Send to

Choose Destination
Blood Rev. 2017 Jul;31(4):193-203. doi: 10.1016/j.blre.2017.02.001. Epub 2017 Feb 5.

Old and new oral anticoagulants: Food, herbal medicines and drug interactions.

Author information

1
Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: alessandro.diminno@ccfm.it.
2
Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: beatrice.frigerio@ccfm.it.
3
Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy. Electronic address: spadarellagaia@hotmail.it.
4
Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: alessio.ravani@ccfm.it.
5
Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: daniela.sansaro@ccfm.it.
6
Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: mauro.amato@ccfm.it.
7
College of Medicine, The Ohio State University, Columbus, OH, USA. Electronic address: joseph.kitzmiller@osumc.edu.
8
Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: mauro.pepi@ccfm.it.
9
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy. Electronic address: elena.tremoli@ccfm.it.
10
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy. Electronic address: damiano.baldassarre@unimi.it.

Abstract

The most commonly prescribed oral anticoagulants worldwide are the vitamin K antagonists (VKAs) such as warfarin. Factors affecting the pharmacokinetics of VKAs are important because deviations from their narrow therapeutic window can result in bleedings due to over-anticoagulation or thrombosis because of under-anticoagulation. In addition to pharmacodynamic interactions (e.g., augmented bleeding risk for concomitant use of NSAIDs), interactions with drugs, foods, herbs, and over-the-counter medications may affect the risk/benefit ratio of VKAs. Direct oral anticoagulants (DOACs) including Factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and thrombin inhibitor (dabigatran) are poised to replace warfarin. Phase-3 studies and real-world evaluations have established that the safety profile of DOACs is superior to those of VKAs. However, some pharmacokinetic and pharmacodynamic interactions are expected. Herein we present a critical review of VKAs and DOACs with focus on their potential for interactions with drugs, foods, herbs and over-the-counter medications.

KEYWORDS:

Co-morbidities; Direct anticoagulant drugs; Loss of efficacy; Patients characteristics; Therapeutic context; Thrombotic/bleeding events; Toxicity; Warfarin

PMID:
28196633
DOI:
10.1016/j.blre.2017.02.001
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center