Clinical Management of Pharmacokinetic Drug Interactions with Direct Oral Anticoagulants (DOACs)

Megan C. Herink, Yan F. Zhuo, Craig D. Williams, Thomas Deloughery

    Research output: Contribution to journalReview article

    Abstract

    Compared with warfarin, the direct-acting oral anticoagulants (DOAC) have fewer pharmacokinetic drug interactions. However, significant drug interactions do exist with documented changes in DOAC concentrations, which can exceed 100%. Unlike warfarin, DOACs have no validated surrogate test to monitor the intensity of anticoagulation. However, several analyses of major outcomes trials with DOACs have demonstrated that serum concentrations do affect both the thrombotic benefits and the hemorrhagic risks of these agents. This paper reviews the known significant pharmacokinetic interactions with DOACs and includes considerations for their use in the presence of interacting medications.

    Original languageEnglish (US)
    JournalDrugs
    DOIs
    StateAccepted/In press - Jan 1 2019

    Fingerprint

    Drug Interactions
    Anticoagulants
    Pharmacokinetics
    Warfarin
    Serum

    ASJC Scopus subject areas

    • Pharmacology (medical)

    Cite this

    Clinical Management of Pharmacokinetic Drug Interactions with Direct Oral Anticoagulants (DOACs). / Herink, Megan C.; Zhuo, Yan F.; Williams, Craig D.; Deloughery, Thomas.

    In: Drugs, 01.01.2019.

    Research output: Contribution to journalReview article

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    AB - Compared with warfarin, the direct-acting oral anticoagulants (DOAC) have fewer pharmacokinetic drug interactions. However, significant drug interactions do exist with documented changes in DOAC concentrations, which can exceed 100%. Unlike warfarin, DOACs have no validated surrogate test to monitor the intensity of anticoagulation. However, several analyses of major outcomes trials with DOACs have demonstrated that serum concentrations do affect both the thrombotic benefits and the hemorrhagic risks of these agents. This paper reviews the known significant pharmacokinetic interactions with DOACs and includes considerations for their use in the presence of interacting medications.

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