Graf Lukas, Korte Wolfgang
Zentrum für Labormedizin, Kantonsspital St. Gallen.
Ther Umsch. 2015 Feb;72(2):99-104. doi: 10.1024/0040-5930/a000650.
Vitamin K antagonists (VKA) top the list of drugs with most drug and dietary interactions and they are among the medications with the highest incidence of life-threatening events. The new direct oral anticoagulants (DOACs) have been developed to overcome many of the disadvantages of a VKA therapy. Especially, fewer clinically significant drug interactions have been reported to date. However, a number of interactions must be considered. These interactions are linked to the DOAC's specific metabolic pathways. The results of these interactions are changes of the DOAC plasma levels leading either to a higher bleeding risk or to a lower therapeutic efficacy. It is known that patients on VKA and on concomitant polymedication show a higher risk of bleeding. Polymedication is more often found in elderly patients. Patients in this population also have more often an indication for an anticoagulant therapy. Various medications are known to lead to an impaired platelet function. An increase of the bleeding risk in case of a platelet function disorder when additionally taking a DOAC is very likely. Therefore, careful consideration of side effects of both DOAC and concomitant medication when prescribing an anticoagulant therapy is mandatory.
维生素K拮抗剂（VKA）在具有最多药物与饮食相互作用的药物中位居榜首，并且它们是发生危及生命事件发生率最高的药物之一。新型直接口服抗凝剂（DOAC）的研发旨在克服VKA治疗的许多缺点。特别是，迄今为止报告的具有临床意义的药物相互作用较少。然而，仍需考虑一些相互作用。这些相互作用与DOAC的特定代谢途径有关。这些相互作用的结果是DOAC血浆水平发生变化，要么导致出血风险增加，要么导致治疗效果降低。众所周知，服用VKA并同时服用多种药物的患者出血风险更高。多种药物联合使用在老年患者中更为常见。该人群中的患者也更常需要进行抗凝治疗。已知多种药物会导致血小板功能受损。在血小板功能障碍的情况下，额外服用DOAC时出血风险很可能会增加。因此，在开具抗凝治疗处方时，必须仔细考虑DOAC和同时服用药物的副作用。
