Mayo Clinic Scottsdale: Mayo Clinic Arizona, Phoenix, AZ, USA.
Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
J Neurooncol. 2022 Apr;157(2):285-296. doi: 10.1007/s11060-022-03984-y. Epub 2022 Mar 21.
Co-administration of direct oral anticoagulants (DOACs) with antiepileptic drugs (AEDs) is increasingly common in brain tumor patients. We therefore performed a systematic review of the current evidence for potential drug interactions between DOACs and AEDs in this patient population.
We conducted a systematic review of the literature via PubMed according to PRISMA guidelines (last accessed December 15, 2021). Included were clinical studies and case reports, written in English language and published between 2010 and 2021, that investigated concurrent clinical use of AEDs with DOACs for any indication. Non-English articles, articles not related to our research question, review articles and commentaries were excluded. Full-text articles were evaluated for possible confounding factors and results were summarized using a data table highlighting the key characteristics of each article.
We identified a total of 122 unique articles, of which 27 were deemed relevant to our research question. Of these, 8 articles were clinical studies (n = 295,415 patients) and 19 were case reports (n = 25 patients). Only 3 clinical studies and 2 case reports reported interactions between AEDs and DOACs in patients with active cancer and none reported interactions in patients with brain tumors.
We have identified low (class IV) level evidence of potential drug interactions between DOACs and AEDs. Even though there is no current report of interactions in brain tumor patients, neuro-oncology providers should be aware of the emerging evidence regarding drug interactions between DOACs and AEDs and take this into consideration when concurrently prescribing these to patients.
脑肿瘤患者同时使用直接口服抗凝剂（DOAC）和抗癫痫药物（AED）的情况越来越多。因此，我们对目前关于这一患者人群中 DOAC 和 AED 之间潜在药物相互作用的证据进行了系统评价。
我们根据 PRISMA 指南（最后访问日期为 2021 年 12 月 15 日）通过 PubMed 进行了系统文献检索。纳入了 2010 年至 2021 年间发表的研究任何适应症下同时使用 AED 和 DOAC 的临床研究和病例报告，且这些研究均为英文报道。排除了非英文文章、与我们的研究问题无关的文章、综述文章和评论文章。对全文进行评估以确定可能存在的混杂因素，并使用数据表总结每个文章的关键特征。
我们共确定了 122 篇独特的文章，其中 27 篇被认为与我们的研究问题相关。其中，8 篇为临床研究（n=295,415 例患者），19 篇为病例报告（n=25 例患者）。仅有 3 项临床研究和 2 项病例报告报道了 AED 和 DOAC 之间在有活动癌症患者中的相互作用，且均无报道在脑肿瘤患者中存在相互作用。
我们发现了 DOAC 和 AED 之间存在潜在药物相互作用的低（IV 级）水平证据。尽管目前没有脑肿瘤患者相互作用的报道，但神经肿瘤学提供者应意识到关于 DOAC 和 AED 之间药物相互作用的新证据，并在同时为患者开这些药物时考虑到这一点。
