Utilization of Direct Oral Anticoagulants in People Living with Human Immunodeficiency Virus: Observational Data from the District of Columbia Cohort.
HIV
anticoagulation
antiretrovirals
cobicistat
ritonavir
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
17 12 2020
17 12 2020
Historique:
received:
23
10
2019
accepted:
13
03
2020
pubmed:
18
3
2020
medline:
29
4
2021
entrez:
18
3
2020
Statut:
ppublish
Résumé
Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people living with human immunodeficiency virus (PWH) are not well described. The coadministration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic interactions. A longitudinal cohort study was conducted using the D.C. Cohort Database in Washington, D.C., from January 2011 to March 2017, to describe oral anticoagulant prescribing among PWH ≥ 18 years old and the prevalence of DOAC use with RTV or COBI. Data collection included demographic and clinical characteristics, ARV and anticoagulant prescriptions, and International Classification of Diseases Ninth and Tenth Edition diagnosis codes. Among 8315 PWH, there were 236 anticoagulant prescriptions (96 DOAC, 140 warfarin) for 206 persons. PWH prescribed anticoagulants were predominantly Black (82%) and male (82%), with a mean age at anticoagulant initiation of 56 years. DOAC use increased from 3% of total anticoagulant prescribing in 2011 to 43% in 2016, accounting for 64% of all newly recorded anticoagulant prescriptions by 2016. There were 19 bleeding events recorded among 16 individuals. Despite the Food and Drug Administration label recommendation to avoid rivaroxaban with boosted ARVs, 41% remained on boosted ARVs after rivaroxaban initiation. DOAC use increased substantially in PWH by 2016. Although rivaroxaban is not recommended with RTV or COBI, concomitant use was recorded in 41% of rivaroxaban recipients in this cohort. As DOAC usage increases, clinicians need to be aware of potential DOAC/ARV interactions in order to select the most appropriate oral anticoagulant and monitoring plan for PWH.
Sections du résumé
BACKGROUND
Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people living with human immunodeficiency virus (PWH) are not well described. The coadministration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic interactions.
METHODS
A longitudinal cohort study was conducted using the D.C. Cohort Database in Washington, D.C., from January 2011 to March 2017, to describe oral anticoagulant prescribing among PWH ≥ 18 years old and the prevalence of DOAC use with RTV or COBI. Data collection included demographic and clinical characteristics, ARV and anticoagulant prescriptions, and International Classification of Diseases Ninth and Tenth Edition diagnosis codes.
RESULTS
Among 8315 PWH, there were 236 anticoagulant prescriptions (96 DOAC, 140 warfarin) for 206 persons. PWH prescribed anticoagulants were predominantly Black (82%) and male (82%), with a mean age at anticoagulant initiation of 56 years. DOAC use increased from 3% of total anticoagulant prescribing in 2011 to 43% in 2016, accounting for 64% of all newly recorded anticoagulant prescriptions by 2016. There were 19 bleeding events recorded among 16 individuals. Despite the Food and Drug Administration label recommendation to avoid rivaroxaban with boosted ARVs, 41% remained on boosted ARVs after rivaroxaban initiation.
CONCLUSIONS
DOAC use increased substantially in PWH by 2016. Although rivaroxaban is not recommended with RTV or COBI, concomitant use was recorded in 41% of rivaroxaban recipients in this cohort. As DOAC usage increases, clinicians need to be aware of potential DOAC/ARV interactions in order to select the most appropriate oral anticoagulant and monitoring plan for PWH.
Identifiants
pubmed: 32179901
pii: 5808710
doi: 10.1093/cid/ciaa284
pmc: PMC7744993
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e604-e613Subventions
Organisme : NIAID NIH HHS
ID : P30 AI117970
Pays : United States
Organisme : NIAID NIH HHS
ID : R24 AI152598
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069503
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI069503
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261200800001E
Pays : United States
Investigateurs
Jeffery Binkley
(J)
Rob Taylor
(R)
Nabil Rayeed
(N)
Cheryl Akridge
(C)
Stacey Purinton
(S)
Qingjiang Hou
(Q)
Jeff Naughton
(J)
David Parfitt
(D)
Lawrence D'Angelo
(L)
Natella Rahkmanina
(N)
Michael Kharfen
(M)
Michael Serlin
(M)
Princy Kumar
(P)
David Parenti
(D)
Amanda Castel
(A)
Alan Greenberg
(A)
Anne Monroe
(A)
Lindsey Powers Happ
(LP)
Maria Jaurretche
(M)
Brittany Wilbourn
(B)
James Peterson
(J)
Matthew Levy
(M)
Morgan Byrne
(M)
Yan Ma
(Y)
Ronald Wilcox
(R)
Sohail Rana
(S)
Michael Horberg
(M)
Ricardo Fernandez
(R)
Safia Kuriakose
(S)
Annick Hebou
(A)
Carl Dieffenbach
(C)
Jomy George
(J)
Colleen Hadigan
(C)
Henry Masur
(H)
Alice Pau
(A)
Jose Bordon
(J)
Gebeyehu Teferi
(G)
Debra Benator
(D)
Maria Elena Ruiz
(ME)
Deborah Goldstein
(D)
Informations de copyright
Published by Oxford University Press for the Infectious Diseases Society of America 2020.