Deans' stroke musings: Combining newer anticoagulants with some other drugs may be risky

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, October 4, 2017

Combining newer anticoagulants with some other drugs may be risky

Ask your doctor if they have taken this into account for your anticoagulant needs. Since I'm on atorvastatin I'll have to remind my doctor of this if I ever need NOACs.
https://www.mdlinx.com/family-medicine/top-medical-news/article/2017/10/04/7470762?

Reuters Health News

Combining several commonly prescribed medications with non-vitamin K oral anticoagulants (NOACs) may increase the risk of major bleeding in patients with nonvalvular atrial fibrillation (AF), suggest results of an observational study from Taiwan.
“Physicians should consider the potential risks associated with the concurrent use of NOACs and other drugs,” Dr. Shang-Hung Chang from Chang Gung Memorial Hospital in Taoyuan told Reuters Health by email. In particular, “combining fluconazole with NOACs looks risky based on the findings.
Physicians shall choose alternative whenever possible,” Dr. Chang said.
NOACs are increasingly being used instead of warfarin because of their ease of administration and comparable efficacy in patients with AF. However, they often are prescribed with other medications that share metabolic pathways that may increase the risk of bleeding.
To investigate, Dr. Chang and colleagues analyzed data from the Taiwan National Health Insurance database on 91,330 adults with nonvalvular AF who received at least one NOAC prescription (dabigatran, rivaroxaban, or apixaban).
They estimated the risk of major bleeding associated with or without the concurrent use of medications that share metabolic pathways with NOACs: atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; and phenytoin.
During the 5-year study period (from 2012 through 2016), there were 4,770 major bleeding events, defined as hospitalization or ED visit with a primary diagnosis of intracranial hemorrhage or gastrointestinal, urogenital, or other bleeding.
Diltiazem and amiodarone were among the most common medications co-prescribed with a NOAC, despite guidance against their combined use, the authors note. Atorvastatin and digoxin were the other two most commonly co-prescribed medications.
According to the study team, the risk of major bleeding was significantly higher when a NOAC was combined with amiodarone, fluconazole, rifampin, or phenytoin rather than with a NOAC alone.
Adjusted incidence rates per 1,000 person-years were 38 for NOAC use alone versus 52 with concurrent use of amiodarone; corresponding rates were 103 versus 242 with fluconazole, 66 versus 103 for rifampin, and 56 vs 109 for phenytoin (P < 0.01 for all comparisons).
The other combinations did not confer increased risk of major bleeding, while atorvastatin, digoxin and erythromycin or clarithromycin were associated with a reduced risk of major bleeding.
To the authors' knowledge, this is the first nationwide population-based study to gauge the risk of major bleeding associated with a drug-drug interaction with NOACs.
They note that because the bleeding risk and anticoagulant treatment in the Asian population may differ from that of Western populations, the findings may not generalize to the West. The analyses also did not consider dosages of NOACs and the other medications, and kidney and liver function data were not available.