Abstract Number: PB2492
Meeting: ISTH 2020 Congress
Background: Current guidelines recommend caution when prescribing with direct oral anticoagulants (DOACs) patients concurrently taking antiepileptic drugs (AED), with particular regard to levetiracetam and valproic acid. Available data suggest a possible drug-drug interaction potentially leading to decreased DOACs plasma level and treatment failure.
Aims: We collected data on patients taking DOACs together with AEDs in order to evaluate the occurrence of DOACs failure during clinical follow-up.
Methods: In this case series, we report data on patients consecutively referred to our center receiving concurrent treatment with AED and DOACs (both for prevention of arterial embolism in atrial fibrillation [AF] and treatment of venous thromboembolism [VTE]). Data on clinical history and reasons for drug prescription, as well as plasma levels of DOACs and AEDs were collected. Patients were regularly followed as outpatient and information on cerebrovascular events and/or venous thrombosis was collected.
Results: We report data on 14 patients treated with DOACs + AEDs . The mean age at referral was 69±15 years; 43% (6/14) of patients were males. VTE treatment was the main reason for DOACs prescription (64.3%), being epilepsy prevention the indication for AED prescription. Five patients were taking apixaban, 4 rivaroxaban, 3 dabigatran and 2 edoxaban. Levetiracetam and valproic acid were the most prescribed AEDs (5 and 5 patients, respectively), while a minority of patients were treated with phenobarbital and phenytoin. At the laboratory tests, 13/14 patients had in-range values of DOACs; 1 patient on levetiracetam had dabigatran levels close to the lower limit. During a period of DOAC+AED treatment of 10±9 months (range 1-27 months), no adverse events were reported.
Conclusions: In our experience, concurrent treatment with AED and DOAC usually did not lead to a reduction in drug concentration. In a clinical follow-up, in both AF and VTE patients, no adverse events due to reduced DOACs effect have been registered at present.
To cite this abstract in AMA style:Barbar S, Simonetto M, De Bon E, Scarano L, Caneve G, Simioni N. Direct Oral Anticoagulants and Antiepileptic Drugs: Is There Room for Concurrent Treatment? [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-and-antiepileptic-drugs-is-there-room-for-concurrent-treatment/. Accessed January 23, 2022.
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