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Interacting medication use and the treatment effects of apixaban versus warfarin: results from the ARISTOTLE Trial
Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
Goethe Univ Frankfurt, Frankfurt, Germany.
Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
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2019 (English)In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 47, no 3, p. 345-352Article in journal (Refereed) Published
Abstract [en]

Warfarin is dependent on multiple hepatic enzymes for metabolism while apixaban is a substrate for P-glycoprotein (P-gp) transport and hepatic CYP3A4 metabolism. The aim of this analysis was to assess the impact of interacting medication use on the treatment effects of apixaban versus warfarin. Outcomes were compared between apixaban and warfarin using Cox proportional hazards modeling according to the use of interacting medications at randomization in ARISTOTLE (n=18,201). Interacting medications for apixaban were identified as combined P-gp and 3A4 inhibitors or inducers while interacting medications for warfarin were defined as those highly probable for warfarin potentiation or inhibition. At randomization, 5547 (30.5%) patients were on an interacting medication, including 2722 on apixaban and 2825 on warfarin. Patients using an interacting medication were more likely to be female, taking aspirin, and have a history of prior bleeding and were less likely to have a prior stroke or transient ischemic attack. No significant differences were observed on the treatment effect of apixaban compared with warfarin in patients on and off interacting medications for outcomes including the primary efficacy outcome of stroke or systemic embolism (P for interaction=0.79) or the primary safety outcome of major bleeding (P for interaction=0.75). Use of interacting medications with anticoagulants occurs often in patients with atrial fibrillation. Despite the potential for altered exposure, interacting medication use was not associated with a significant change in the efficacy or safety of apixaban compared with warfarin in the ARISTOTLE trial.Trial registration ClinicalTrials.gov, NCT00412984

Place, publisher, year, edition, pages
SPRINGER , 2019. Vol. 47, no 3, p. 345-352
Keywords [en]
Atrial fibrillation, Interacting medications, Warfarin, Apixaban
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-382509DOI: 10.1007/s11239-019-01823-yISI: 000463674900002PubMedID: 30790160OAI: oai:DiVA.org:uu-382509DiVA, id: diva2:1308062
Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-04-30Bibliographically approved

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