Abstracts

Rationale: Novel oral anticoagulant medications including dabigatran etexilate, rivaroxaban, apixaban and edoxaban provide safe and convenient alternative for the traditional anticoagulation with vitamin K antagonists and heparin derivatives. Frequent encounters of patients receiving life-long seizure prophylaxis with anticonvulsants and anticoagulation with non-vitamin K oral anticoagulants (NOAC) warrants an advice for guiding the potential drug interactions and the relevant clinical consequences. Methods: To highlight the need for further research in this area, a systematic review of the existing literature on the clinically relevant interactions between NOAC and anti-seizure medications was prepared using Medline, Embase, Cochrane Library and SciFinder. The search strategy was developed using keywords of new oral anticoagulation and antiepileptic medications. Two individuals reviewed the results independently and performed abstract and full report review and data gathering. Results: A total of 566 studies were obtained from database. After exclusion of duplicates (63), records of 503 were reviewed and 82 abstracts were selected from which 17 articles were included. Carbamazepine, phenytoin, and phenobarbital were reported to interact with NOAC. The main form of interaction was through CYP3A4 enzyme induction and P-glycoprotein-related competition. These interaction lead to either decreased NAOC plasma levels or development of thrombotic events. Conclusions: Providers should be familiar with potential clinically significant interactions between NOAC and anticonvulsants and be aware of the use of drug level measurements to manage patients receiving these agents. Funding: No funding