Wuyts Stephanie C M, Bonte Sophie, Thielemans Naomi, Vandervorst Fenne, von Kemp Berlinde, Steurbaut Stephane, Dupont Alain G, Cornu Pieter
Pharmacy Department, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels, 1090, Belgium.
Research Centre for Digital Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium.
Cardiovasc Drugs Ther. 2025 Apr 8. doi: 10.1007/s10557-025-07691-4.
Physicians can be supported by electronic clinical decision support systems (CDSS) for drug-drug interaction (DDI) management of DDIs between direct oral anticoagulants (DOACs) and CYP3 A4/P-glycoprotein (P-gp) inhibitors and inducers, to prevent adverse drug events (ADEs).
A retrospective cohort study was performed studying DDI alerts for DOAC-CYP3 A4/P-gp influencing drug combination prescriptions in patients admitted to a tertiary care hospital. Patient-, DDI-, and ADE-related data were analyzed to explore CDSS performance and real-world DDI management. A multidisciplinary panel conducted an ADE analysis using the Drug Interaction Probability Scale.
Out of 15,201 triggered CDS alerts, 166 individual alerts were included. Primary indication for DOAC therapy was atrial fibrillation (86.1%). The most involved DOAC was dabigatran (63%). DDI exposure was median 3 days (IQR = 2-7 days). CYP3 A4/P-gp inhibitor DDIs were most prevalent (n = 121), with amiodarone being most prevalently prescribed (71%). Inducers were mainly antiepileptic drugs (n = 31). Thirty-four CDS alerts (20%) were actively shown to the physician upon prescribing (acceptance rate 50%). Eighteen ADEs were identified (11%, 14 bleeding; 4 thromboembolic events), 15 having a possible and 3 a probable probability of being DDI associated.
Despite a low number of observed, potentially associated ADEs, CDSS for DDI management aids physicians to optimize DOAC treatment as the described DDIs can cause significant patient harm. Increased ADE monitoring and larger real-world studies are needed to refine CDS tools and further optimize patient safety.
电子临床决策支持系统（CDSS）可为医生提供支持，用于管理直接口服抗凝剂（DOAC）与CYP3A4/ P-糖蛋白（P-gp）抑制剂和诱导剂之间的药物相互作用（DDI），以预防药物不良事件（ADE）。
进行了一项回顾性队列研究，研究三级护理医院收治患者中DOAC-CYP3A4/ P-gp影响药物联合处方的DDI警报。分析患者、DDI和ADE相关数据，以探索CDSS性能和实际DDI管理情况。一个多学科小组使用药物相互作用概率量表进行了ADE分析。
在15201条触发的CDS警报中，纳入了166条个体警报。DOAC治疗的主要适应症是心房颤动（86.1%）。涉及最多的DOAC是达比加群（63%）。DDI暴露的中位数为3天（四分位间距=2-7天）。CYP3A4/ P-gp抑制剂DDI最为普遍（n = 121），其中胺碘酮的处方最为普遍（71%）。诱导剂主要是抗癫痫药物（n = 31）。34条CDS警报（20%）在开处方时主动显示给医生（接受率50%）。识别出18起ADE（11%，14起出血；4起血栓栓塞事件），其中15起可能与DDI相关，3起很可能与DDI相关。
尽管观察到的潜在相关ADE数量较少，但用于DDI管理的CDSS有助于医生优化DOAC治疗，因为所述DDI可能对患者造成重大伤害。需要加强ADE监测并开展更大规模的实际研究，以完善CDS工具并进一步优化患者安全。
