Abstract Number: PB2481
Meeting: ISTH 2020 Congress
Background: Warfarin has been the mainstay anticoagulation option for people with human immunodeficiency virus (HIV). Direct oral anticoagulants (DOACs) offer fixed dosing, predictable effects and no regular anticoagulation monitoring but research is lacking on efficacy and safety of DOACs with concurrent antiretroviral medication (ARVM) use. Theoretical drug interactions between DOACs and antiretrovirals exist but the clinical signification of these interactions is unknown.
– To assess the safety of DOACs in patients with HIV
– To assess effects of drug-drug interactions with DOACs and ARVM
Methods: Patients prescribed DOAC and ARVM between January 2018 and July 2019 were included via electronic prescribing records. Data collection included: patient demographics, co-morbidities, HIV status, indication for anticoagulation therapy, DOAC and ARVM details, and review of medication switches and adverse effects.
Results: 16 patients (mean age 66 years; male 81% and female 19%) were identified with well controlled HIV; of these patients DOAC indication was: AF (9), VTE treatment (4), AF and VTE treatment (1), thromboprophylaxis following orthopaedic surgery (1), and other (1-thrombus in descending abdominal aorta). 31% (n=5/16) patients were on DOAC, antiplatelet and ARVM. Patients were prescribed apixaban (4), rivaroxaban (8), and dabigatran (3). One patient switched from rivaroxaban to apixaban due to pulmonary embolism on rivaroxaban therapy.
In one patient on apixaban a potential interaction with Rezolsta (protease inhibitor) was identified with no clinical consequences. One patient had appropriate dose reduction of dabigatran due to co-administration with voriconazole. For the remainder of patients, there were no significant drug interactions.
There were two bleeding events. One patient stopped apixaban due to upper gastrointestinal bleeding. One patient on rivaroxaban and aspirin with ischaemic heart disease and peripheral vascular disease developed intracranial haemorrhage.
Conclusions: DOACs can be considered the anticoagulant of choice to most patients with HIV, although drug-drug interactions should be considered.
To cite this abstract in AMA style:Patel S, Godfrey A. A Single Centre Experience on the Use of Direct Oral Anticoagulants in People with Human Immunodeficiency Virus (HIV) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-single-centre-experience-on-the-use-of-direct-oral-anticoagulants-in-people-with-human-immunodeficiency-virus-hiv/. Accessed January 26, 2022.
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