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Clinical Research in Cardiology

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01-04-2020 | Anticoagulant | Original Paper

Drug interactions with oral anticoagulants in German nursing home residents: comparison between vitamin K antagonists and non-vitamin K antagonist oral anticoagulants based on two nested case–control studies

Authors: Kathrin Jobski, Falk Hoffmann, Stefan Herget-Rosenthal, Michael Dörks

Published in: Clinical Research in Cardiology | Issue 4/2020

Abstract

Background

Vitamin K antagonists (VKAs) are susceptible to drug–drug interactions. Non-VKA oral anticoagulants (NOACs) have a decreased sensitivity to pharmacokinetic interactions and might be therefore considered superior in patients treated with multiple drugs. The objective of this study was to compare the risk of serious bleeding associated with interacting drugs in German nursing home residents treated with VKA or NOAC.

Methods

Using claims data of new nursing home residents aged ≥ 65 years (2010–2014) we conducted separate nested case–control analyses within two cohorts of patients treated with VKA or NOAC, respectively. Cases were defined as patients hospitalized for serious bleeding. For each case, up to 20 controls were selected by risk-set sampling. Conditional logistic regression was used to obtain confounder-adjusted odds ratios (aORs) and 95% confidence intervals (CI) for the risk of bleeding associated with VKA or NOAC use and interacting drugs compared with the use of the respective oral anticoagulant alone.

Results

Among 127,227 new nursing home residents, 16,804 patients received oral anticoagulation. Based on 372 cases and 7281 matched controls, the highest risk of bleeding in VKA users was observed for the concomitant use of antibiotics (aOR 3.00; CI 2.11–4.27) vs. VKA use alone, followed by non-steroidal anti-inflammatory drugs (1.66; 1.13–2.43). Among 243 NOAC cases and 4776 matched controls, elevated risks for bleeding were observed for the use of heparins (2.05; 1.25–3.36) and platelet inhibitors (1.92; 1.36–2.72).

Conclusions

Concomitant medication needs to be prescribed cautiously and monitored closely in nursing home residents treated with oral anticoagulants.

Graphic Abstract

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Title: Drug interactions with oral anticoagulants in German nursing home residents: comparison between vitamin K antagonists and non-vitamin K antagonist oral anticoagulants based on two nested case–control studies
Authors: Kathrin Jobski
Falk Hoffmann
Stefan Herget-Rosenthal
Michael Dörks
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Anticoagulant
Care
Oral Anticoagulant
Atrial Fibrillation
Heparin
Published in: Clinical Research in Cardiology / Issue 4/2020
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-019-01526-7

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Drug interactions with oral anticoagulants in German nursing home residents: comparison between vitamin K antagonists and non-vitamin K antagonist oral anticoagulants based on two nested case–control studies

Abstract

Background

Methods

Results

Conclusions

Graphic Abstract

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Abstract

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