2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Wien, Austria.
Klinik Landstrasse, Vienna, Austria.
Expert Rev Clin Pharmacol. 2021 May;14(5):569-581. doi: 10.1080/17512433.2021.1908124. Epub 2021 Mar 30.
: We update the knowledge, since the last review in 2017, about drug-drug interactions (DDI) of non-vitamin-K-antagonist oral anticoagulants (NOAC) in patients ≥75 years.: The literature was searched for: 'dabigatran,' 'rivaroxaban,' 'edoxaban,' or 'apixaban' and drugs, affecting platelet function, CYP3A4-, CYP2C9-, or P-Gp-activity. Pharmacodynamic DDI of NOAC with drugs affecting platelet function like nonsteroidal anti-inflammatory drugs and antiplatelet agents occur most frequently. Pharmacokinetic DDI with NOAC were found for 37 of 117 drugs. Reports about DDI with NOAC were found for 51% of P-gp-affecting, 38% for CYP2C9-affecting and 27% for CYP3A4-affecting drugs. Reports about DDI of cardiovascular drugs with NOAC were the most prevalent, followed by anti-infective and nervous system drugs. NOAC plasma levels were measured in retrospective and cohort studies and were associated with concomitant medication. Reports about DDI of NOAC were found in 71 patients ≥75 years.: The knowledge about DDI of NOAC in elderly patients is very limited. Studies should be carried out to investigate the role of drugs potentially interacting with NOAC, which until now have not been investigated. When studying DDI of NOAC, care should be taken to include elderly patients with impaired renal function and patients on polymedication.
: 我们更新了知识，自 2017 年上次综述以来，关于非维生素 K 拮抗剂口服抗凝剂 (NOAC) 在≥75 岁患者中的药物相互作用 (DDI)。：文献检索了“达比加群”、“利伐沙班”、“依度沙班”或“阿哌沙班”和影响血小板功能、CYP3A4、CYP2C9 或 P-Gp 活性的药物。NOAC 与影响血小板功能的药物（如非甾体抗炎药和抗血小板药物）发生药效学 DDI 最为常见。与 NOAC 发生药代动力学 DDI 的有 117 种药物中的 37 种。报告了 51%的 P-gp 影响药物、38%的 CYP2C9 影响药物和 27%的 CYP3A4 影响药物与 NOAC 的 DDI。报告了心血管药物与 NOAC 的 DDI 最多，其次是抗感染药和神经系统药物。NOAC 血药浓度在回顾性和队列研究中进行了测量，并与伴随用药相关。在≥75 岁的 71 名患者中发现了与 NOAC 相关的 DDI 报告。：关于老年患者中 NOAC 的 DDI 知识非常有限。应开展研究，以调查可能与 NOAC 相互作用的药物的作用，这些药物迄今为止尚未得到研究。在研究 NOAC 的 DDI 时，应注意包括肾功能受损和多药治疗的老年患者。
