Bellia Alfonso, Della-Morte David, Di Daniele Nicola, Lauro Davide
Department of Systems Medicine, University of Rome Tor Vergata, Italy.
Unit Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Italy.
Curr Res Pharmacol Drug Discov. 2021 May 21;2:100029. doi: 10.1016/j.crphar.2021.100029. eCollection 2021.
In the present review we summarized current knowledge about significant interactions (DIs) of direct oral anticoagulants (DOACs) with other medications frequently prescribed to elderly patients with cardiometabolic diseases. Literature search was performed using PubMed from 1990 to October 2020. Randomized clinical trials (RCTs), subgroup analyses from RCTs, longitudinal studies, case series and case reports were included. Only studies in humans were considered. Elderly was defined as ≥75 years. Assessment of DIs with DOACs is often tricky because of the lack of validated tools to routinely assess magnitude of their anti-coagulation effect. Most of reports in the cardiometabolic area regarded the classes of anti-antiarrhythmic, lipid-lowering and platelet-inhibitors drugs, namely drugs that are widely used to reduce cardiovascular risk in patients with common metabolic diseases. Reports about elderly are limited in general, and it is not known whether certain types of DIs occur more frequently in elderly subjects. DIs were more frequently reported in association with dabigatran, which however has been available for a longer period of time compared with other DOACs. In most cases, no complete information about dosages of medications was available. DIs of DOACs leading to adverse events (both ischemic and bleeding ones) were generally facilitated by older age, polymedication and impaired renal function. Further studies should be carried out to properly investigate DIs of DOACs with cardiometabolic drugs in elderly patients, with particular focus on differences between DOACs and the influence of different dosages.
在本综述中，我们总结了目前关于直接口服抗凝剂（DOACs）与其他常用于患有心脏代谢疾病老年患者的药物之间显著相互作用（DIs）的知识。使用PubMed对1990年至2020年10月的文献进行了检索。纳入了随机临床试验（RCTs）、RCTs的亚组分析、纵向研究、病例系列和病例报告。仅考虑人体研究。老年人定义为年龄≥75岁。由于缺乏常规评估其抗凝作用强度的有效工具，评估DOACs的药物相互作用往往很棘手。心脏代谢领域的大多数报告涉及抗心律失常、降脂和抗血小板药物类别，即广泛用于降低常见代谢疾病患者心血管风险的药物。关于老年人的报告总体有限，尚不清楚某些类型的药物相互作用在老年受试者中是否更频繁发生。与达比加群相关的药物相互作用报告更为频繁，然而与其他DOACs相比它上市时间更长。在大多数情况下，没有关于药物剂量的完整信息。导致不良事件（缺血性和出血性）的DOACs药物相互作用通常因年龄较大、多种药物联用和肾功能受损而加剧。应开展进一步研究，以恰当调查老年患者中DOACs与心脏代谢药物的药物相互作用，尤其关注不同DOACs之间的差异以及不同剂量的影响。
