Nowinski Karolina, Chaireti Roza
Department of Clinical Pharmacology, Karolinska University Hospital, SE 14186 Stockholm, Sweden.
Department of Laboratory Medicine, Karolinska Institutet, SE 17176 Stockholm, Sweden.
Pharmaceuticals (Basel). 2025 Jul 16;18(7):1044. doi: 10.3390/ph18071044.
In some cases of concomitant use of direct oral anticoagulants (DOAC) and certain anticancer medications, pharmacokinetic interactions are expected; however, clinical data is scarce. This report reviews the recommendations on the use of DOAC concurrently with anticancer drugs according to different clinical decision support systems and sources, with a focus on discrepancies. We reviewed the recommendations from the American Heart Association (AHA), European Heart Rhythm Association (EHRA), summary of product characteristics (SPC) in FASS (Swedish medicine information portal), the Swedish clinical decision support system Janusmed, and information from the Food and Drug Administration (FDA) on the concomitant use of apixaban, edoxaban, and rivaroxaban (activated factor X (FXa) inhibitors) and 80 anticancer drugs from 11 categories (240 drug pairs). No warnings of expected pharmacokinetic drug interactions between FXa inhibitors and anticancer drugs were found for 155 drug pairs (65%) across all sources. The remaining 35% of drug pairs were flagged as having possible interactions with FXa inhibitors according to at least one source. Discrepancies in the recommendations from the different sources were reported. The reported discrepancies were, for the most part, associated with different assessments of the mechanism and the extent of pharmacokinetic interactions of each anticancer medication. Also, knowledge sources have different approaches to reporting potential interactions, in some cases reporting clinically relevant strictly pharmacokinetic interactions, whereas others include even patient-specific factors. The lack of clinical data and different recommendations can make clinical decisions on the concomitant use of DOAC and anticancer drugs difficult. Our compilation is meant to assist clinicians in making decisions based on the available evidence, even if it is scarce.
在某些直接口服抗凝剂（DOAC）与某些抗癌药物联合使用的情况下，预计会发生药代动力学相互作用；然而，临床数据却很匮乏。本报告根据不同的临床决策支持系统和信息来源，回顾了DOAC与抗癌药物联合使用的相关建议，重点关注其中的差异。我们查阅了美国心脏协会（AHA）、欧洲心律协会（EHRA）、瑞典药品信息门户网站FASS中的产品特性摘要（SPC）、瑞典临床决策支持系统Janusmed，以及美国食品药品监督管理局（FDA）关于阿哌沙班、依度沙班和利伐沙班（活化因子X（FXa）抑制剂）与11类80种抗癌药物联合使用的信息（共240种药物组合）。在所有信息来源中，155种药物组合（65%）未发现FXa抑制剂与抗癌药物之间存在预期的药代动力学药物相互作用的警告。其余35%的药物组合至少在一个信息来源中被标记为可能与FXa抑制剂存在相互作用。报告了不同信息来源建议中的差异。所报告的差异大多与对每种抗癌药物药代动力学相互作用的机制和程度的不同评估有关。此外，知识来源在报告潜在相互作用方面有不同的方法，在某些情况下报告严格意义上的临床相关药代动力学相互作用，而其他一些则甚至包括患者特异性因素。临床数据的缺乏和不同的建议可能会使关于DOAC与抗癌药物联合使用的临床决策变得困难。我们的汇编旨在帮助临床医生根据现有证据（即使证据稀少）做出决策。
