Non-Vitamin K Oral Anticoagulant Use In Epilepsy Patients
Abstract number :
1.323
Submission category :
7. Antiepileptic Drugs / 7D. Drug Side Effects
Year :
2019
Submission ID :
2421318
Source :
www.aesnet.org
Presentation date :
12/7/2019 6:00:00 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Chen-Jui Ho, Chang Gung Memorial Hospital Kaohsiung B; Yan-Ting Lu, Chang Gung Memorial Hospital Kaohsiung; Chih-Hsiang Lin, Chang Gung Memorial Hospital Kaohsiung; Meng-Han Tsai, Chang Gung Memorial Hospital Kaohsiung
Rationale: The concern of drug-drug interaction (DDI) between anti-epileptic drugs (AEDs) and non-vitamin K oral anticoagulants (NOACs) have been raised in recent animal studies, case report/series, and guidelines. Theoretically, the induction of hepatic cytochrome P 450 3A4 (CYP) enzymes and permeability glycoprotein (P-GP) efflux transporter protein system may reduce the effect of NOAC, therefore, a higher chance of recurrent stroke. We aim to investigate whether these drug-drug interactions are clinically relevant in real-world patients. Methods: We retrospectively reviewed our stroke registry of 549 patients with atrial fibrillation (Af). Patients were grouped according to different potential interaction with CYP and P-GP. To avoid confounding interactions, we excluded patients exposed other CYP and P-GP inducers other than AEDs. Stroke events, transient ischemic attack (TIA) events, follow up duration, baseline characteristics, concomitant AEDs, and stroke risk factors were collected. Statistical analysis included Kaplan-Meier survival curves and log rank test. Results: Overall, 407 Af patients received anticoagulants use and 97(23.8%) patients had concomitant AEDs. Among them, 58 patients had both potential CYP and P-GP DDIs, 20 patients had only P-GP DDI, and 19 patients had no potential DDI with NOAC. Kaplan-Meier survival curves did not show the significant difference and the log rank test between groups were not statistically significant. The incidence rate of recurrent stroke/TIA events in the three groups (CYP3A4 and P-GP DDI, P-GP only DDI, and no DDIs) were 7.5, 2.1, and 8.4/100 person-year, respectively. Conclusions: The recurrent stroke rate of potential DDIs in our study cohort was similar to patients without potential DDIs. Our study suggests that DDIs between AEDs and NOACs may not be as severe as we previously thought in real-world situation. Due to the limit number and duration of follow up, further studies may be worthwhile to clarify the clinical significance of these drug-drug interactions. Funding: No funding
Antiepileptic Drugs