Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA.
Clin Infect Dis. 2020 Dec 17;71(10):e604-e613. doi: 10.1093/cid/ciaa284.
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.
直接口服抗凝剂（DOACs）已成为静脉血栓栓塞事件的一线治疗药物。但目前对于接受人类免疫缺陷病毒（HIV）治疗人群（PWH）的 DOAC 处方趋势尚不清楚。DOAC 与抗逆转录病毒（ARV）药药代动力学增强剂利托那韦（RTV）或考比司他（COBI）合用可能会因药物相互作用而变得复杂。
本研究采用华盛顿特区 D.C. 队列数据库，对 2011 年 1 月至 2017 年 3 月期间≥18 岁的 PWH 进行了一项纵向队列研究，以描述 PWH 中口服抗凝药物的使用情况以及使用 RTV 或 COBI 的 DOAC 使用率。数据收集包括人口统计学和临床特征、ARV 和抗凝药物处方以及国际疾病分类第九和第十版诊断代码。
在 8315 名 PWH 中，共有 206 名患者接受了 236 例抗凝治疗（96 例 DOAC，140 例华法林）。接受抗凝治疗的 PWH 主要为黑人（82%）和男性（82%），抗凝治疗起始时的平均年龄为 56 岁。DOAC 的使用比例从 2011 年的抗凝总处方的 3%增加到 2016 年的 43%，并在 2016 年占到了所有新记录的抗凝处方的 64%。在 16 名患者中记录了 19 例出血事件。尽管美国食品和药物管理局（FDA）的标签建议避免将利伐沙班与增强型 ARV 合用，但在开始使用利伐沙班后，仍有 41%的患者继续使用增强型 ARV。
到 2016 年，PWH 中 DOAC 的使用大幅增加。尽管 FDA 不建议将利伐沙班与 RTV 或 COBI 合用，但在本队列中，仍有 41%的利伐沙班使用者同时使用了这两种药物。随着 DOAC 的使用增加，临床医生需要意识到潜在的 DOAC/ARV 相互作用，以便为 PWH 选择最合适的口服抗凝药物和监测方案。
