Menichelli Danilo, Pastori Daniele, Pignatelli Pasquale, Pani Arianna
Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Department of Oncology and Hemato-oncology, Postgraduate School of Clinical Pharmacology, University of Milan, Via Festa del Perdono 720122 Milano, Italy.
Eur Heart J Case Rep. 2023 Jan 6;7(1):ytad006. doi: 10.1093/ehjcr/ytad006. eCollection 2023 Jan.
Direct oral anticoagulants (DOACs) are useful for stroke prevention in atrial fibrillation (AF) patients. However, the concomitant administration of Levetiracetam limited their use in clinical practice, although some authors raise doubts about clinical relevance of the interaction.
We report a case of a 54-year-old male with AF, cirrhosis, and seizures, in which the assessment of Dabigatran plasma concentration was needed due to the concomitant use of Levetiracetam. In this case, no relevant reduction of trough Dabigatran plasma concentration was found. An increased peak serum level of dabigatran may be obtained delaying levetiracetam administration. The patient was then followed in our clinic and during 32 months of follow-up no ischaemic or haemorrhagic events occurred.
The evaluation of DOACs concentration could be helpful to start a tailored therapy in frailty patients.
直接口服抗凝剂（DOACs）对心房颤动（AF）患者预防中风很有用。然而，左乙拉西坦的联合使用限制了它们在临床实践中的应用，尽管一些作者对这种相互作用的临床相关性表示怀疑。
我们报告了一例54岁男性患者，患有房颤、肝硬化和癫痫，由于同时使用左乙拉西坦，需要评估达比加群血浆浓度。在该病例中，未发现达比加群谷浓度有相关降低。延迟左乙拉西坦给药可能会使达比加群血清峰值水平升高。该患者随后在我们诊所接受随访，在32个月的随访期间未发生缺血性或出血性事件。
评估DOACs浓度可能有助于为体弱患者开展个体化治疗。
