Assessing major bleeding risk in atrial fibrillation patients concurrently taking non-vitamin K antagonist oral anticoagulants and antiepileptic drugs.
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants
/ administration & dosage
Anticonvulsants
/ administration & dosage
Atrial Fibrillation
/ diagnosis
Databases, Factual
Drug Interactions
Epilepsy
/ diagnosis
Female
Hemorrhage
/ chemically induced
Humans
Incidence
Male
Retrospective Studies
Risk Assessment
Risk Factors
Taiwan
/ epidemiology
Time Factors
Treatment Outcome
Antiepileptic drug
Atrial fibrillation
Bleeding
Drug–drug interaction
Non-vitamin K antagonist oral anticoagulant
Journal
European heart journal. Cardiovascular pharmacotherapy
ISSN: 2055-6845
Titre abrégé: Eur Heart J Cardiovasc Pharmacother
Pays: England
ID NLM: 101669491
Informations de publication
Date de publication:
01 07 2020
01 07 2020
Historique:
received:
30
05
2019
revised:
12
07
2019
accepted:
01
08
2019
pubmed:
7
8
2019
medline:
2
12
2020
entrez:
7
8
2019
Statut:
ppublish
Résumé
This study compared the risk of major bleeding between atrial fibrillation (AF) patients who took non-vitamin K antagonist oral anticoagulants (NOACs) and antiepileptic drugs (AEDs) concurrently and those who took only NOACs. We performed a retrospective cohort study using Taiwan National Health Insurance database and included AF patients who received NOAC prescriptions from 1 June 2012 to 31 December 2017. The major bleeding risks of person-quarters exposed to NOAC and 11 concurrent AEDs (carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate, valproic acid, and zonisamide) were compared with person-quarters exposed to NOAC alone. Adjusted incidence rate differences between NOAC with or without concurrent AEDs were estimated using Poisson regression models weighted by the inverse probability of treatment. Among 104 319 patients (age 75.0 ± 10.3 years; men, 56.2%), 8546 major bleeding events occurred during 731 723 person-quarters with NOAC prescriptions. Concurrent AED use was found in 15.3% of NOAC-treated patients. Concurrent use of NOAC with valproic acid, phenytoin, or levetiracetam increased adjusted incidence rates per 1000 person-years of major bleeding more significantly than NOAC alone: 153.49 for NOAC plus valproic acid vs. 55.06 for NOAC alone [difference 98.43, 95% confidence interval (CI) 82.37-114.49]; 135.83 for NOAC plus phenytoin vs. 54.43 for NOAC alone (difference 81.4, 95% CI 60.14-102.66); and 132.96 for NOAC plus levetiracetam vs. 53.08 for NOAC alone (difference 79.88, 95% CI 64.47-95.30). For AF patients, the concurrent use of NOACs and valproic acid, phenytoin, or levetiracetam was associated with a higher risk of major bleeding.
Identifiants
pubmed: 31384926
pii: 5544109
doi: 10.1093/ehjcvp/pvz035
doi:
Substances chimiques
Anticoagulants
0
Anticonvulsants
0
Types de publication
Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
147-154Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.