Stöllberger Claudia
a 2. Med. Abt. , Krankenanstalt Rudolfstiftung , Wien , Austria.
Expert Rev Clin Pharmacol. 2017 Nov;10(11):1191-1202. doi: 10.1080/17512433.2017.1370369. Epub 2017 Aug 28.
This review attempts to summarise what is known about Drug-drug interactions (DDIs) of the new oral anticoagulants (NOACs) in elderly patients. The literature was searched for: 'CYP3A4', 'CYP2C9', 'P-glycoprotein', 'acetylsalicylic-acid', 'non-steroidal anti-inflammatory', 'clopidogrel', 'ticagrelor', 'prasugrel' and 'dabigatran', 'rivaroxaban', 'edoxaban', or 'apixaban'. 'Elderly' was defined as ≥75 years. Areas covered: Publications about DDIs of NOACs were found for 35% of 140 potentially interacting drugs. Reports about DDIs of cardiovascular drugs, were most frequent, followed by anti-infective and nervous system drugs. Reports about elderly were found for only 47 patients. DDIs were reported most frequently in association with dabigatran. Dabigatran is the only NOAC interacting with proton-pump-inhibitors. Expert commentary: Dabigatran was the first NOAC approved, so it is not possible to determine whether the higher number of reports about DDIs with dabigatran compared with other NOACs is due to a higher rate of DDIs or to the length of time during which this drug has been in use. Most of the data is derived from subgroup-analyses of trials, sponsored by NOAC manufacturers, consequently there is a lack of independent data. Because of the scarcity of data, the clinical relevance of DDIs of NOACs is uncertain at present, especially in elderly patients.
本综述旨在总结关于老年患者新型口服抗凝药（NOACs）药物相互作用（DDIs）的已知信息。检索了以下文献：“CYP3A4”“CYP2C9”“P-糖蛋白”“乙酰水杨酸”“非甾体抗炎药”“氯吡格雷”“替格瑞洛”“普拉格雷”以及“达比加群”“利伐沙班”“依度沙班”或“阿哌沙班”。“老年”定义为年龄≥75岁。涵盖领域：在140种可能存在相互作用的药物中，有35%发现了关于NOACs药物相互作用的出版物。关于心血管药物药物相互作用的报告最为常见，其次是抗感染药物和神经系统药物。仅发现47例关于老年患者的报告。药物相互作用报告中最常涉及达比加群。达比加群是唯一与质子泵抑制剂相互作用的NOAC。专家评论：达比加群是首个获批的NOAC，因此与其他NOACs相比，关于达比加群药物相互作用的报告数量较多，这是由于药物相互作用发生率较高还是由于该药物的使用时间较长，目前尚无法确定。大多数数据来自NOAC制造商赞助试验的亚组分析，因此缺乏独立数据。由于数据稀缺，目前NOACs药物相互作用的临床相关性尚不确定，尤其是在老年患者中。
