534521Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211038685. doi: 10.1177/10760296211038685.
Drug interactions with novel oral anticoagulants (NOACs) may decrease their advantages. We aimed to explore the drug interaction rates with NOACs and impacts of drug interaction index (DII) on mortality among older patients with atrial fibrillation (AF). In this retrospective cohort study, we enrolled 704 eligible patients aged 65≤ with AF between January 1, 2018 and December 30, 2019 in a tertiary outpatient cardiology clinic. We recorded demographic, clinical characteristics, and medications for the last 3 months. At the end of the evaluation visit (March 1, 2020), death events and dates were recorded. All medications were checked for drug interactions using Lexicomp® software. Each drug interaction was annotated according to risk grade. Moreover, we determined a new index ratio of C/D/X classes to total interactions called DII. The mean age was 75.19 ± 7.13 and 398 (56%) were male. Death events were observed in 106 (15%) patients. A total of 9883 drugs were analyzed for drug interactions. The majority of drug interactions were in class A (80.7%). Clinically relevant interactions were 14.6% (Class C/D/X). The area under receiver operating characteristic curve was 0.704 (95% confidence interval: 0.653-0.754) and 0.167 cutoff value (68.9% sensitivity and 80.2% specificity [3.11 positive likelihood ratio]) for DII to predict mortality. This study showed an overview of the NOACs interactions in older patients with AF. Additionally, the inappropriate NOAC dose and DII showed an association with mortality. NOAC treatment should be guided by drug interaction applications to reduce mortality.
药物相互作用可能会降低新型口服抗凝剂 (NOACs) 的优势。我们旨在探讨新型口服抗凝剂的药物相互作用发生率以及药物相互作用指数 (DII) 对老年心房颤动 (AF) 患者死亡率的影响。在这项回顾性队列研究中，我们纳入了 2018 年 1 月 1 日至 2019 年 12 月 30 日在一家三级门诊心脏病学诊所就诊的 704 名年龄在 65 岁及以上的符合条件的 AF 患者。我们记录了人口统计学、临床特征和过去 3 个月的药物治疗情况。在评估就诊结束时（2020 年 3 月 1 日），记录死亡事件和日期。使用 Lexicomp®软件检查所有药物的药物相互作用。根据风险等级对每种药物相互作用进行注释。此外，我们确定了一种新的 C/D/X 类药物与总相互作用的比值指数，称为 DII。平均年龄为 75.19±7.13 岁，其中 398 名（56%）为男性。106 名（15%）患者发生死亡事件。分析了 9883 种药物的药物相互作用。大多数药物相互作用为 A 类（80.7%）。临床相关的相互作用为 14.6%（C/D/X 类）。受试者工作特征曲线下面积为 0.704（95%置信区间：0.653-0.754），DII 预测死亡率的截断值为 0.167（68.9%的敏感性和 80.2%的特异性[3.11 阳性似然比]）。本研究概述了老年 AF 患者中新型口服抗凝剂的相互作用。此外，不适当的新型口服抗凝剂剂量和 DII 与死亡率相关。NOAC 治疗应通过药物相互作用应用来指导，以降低死亡率。
