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Carbamazepine interaction with direct oral anticoagulants: help from the laboratory for the personalized management of oral anticoagulant therapy

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Abstract

Current guidelines recommend caution in prescribing concomitant use of direct-acting oral anticoagulants (DOACs) and antiepileptic drugs due to drug–drug interactions leading to potential risk of DOACs subtherapeutic concentration and treatment failure. Herein we report a significant interaction between carbamazepine (CZP) and apixaban, causing subtherapeutic concentration of the drug in a patient with atrial fibrillation who had a transient ischemic attack (TIA) episode. Another anti-Xa DOAC, edoxaban, administered to the patient after TIA occurrence did not show significant interaction with CZP. In addition to confirm that cautions should be used when antiepileptic and DOACs are concomitantly prescribed, the present case also demonstrates that, in the management of certain subsets of patients who need anticoagulant treatment, measurement of DOAC plasma concentration can help guide a personalized management and avoid adverse clinical outcomes.

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Abbreviations

NVAF:

Non-valvular atrial fibrillation

CZP:

Carbamazepine

INR:

International normalized ratio

DOAC:

Direct non-vitamin K antagonist oral anticoagulant

VKA:

Vitamin-K antagonist

TIA:

Transient ischemic attack

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Authors and Affiliations

  1. Unità Operativa Malattie Emorragiche e Trombotiche, Area di Ematologia, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Rome, Italy

    Leonardo Di Gennaro, Stefano Lancellotti, Raimondo De Cristofaro & Erica De Candia

  2. Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy

    Raimondo De Cristofaro & Erica De Candia

  3. Unità Operativa Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCS, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy

    Erica De Candia

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  1. Leonardo Di Gennaro
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  2. Stefano Lancellotti
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  4. Erica De Candia
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Correspondence to Erica De Candia.

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Di Gennaro, L., Lancellotti, S., De Cristofaro, R. et al. Carbamazepine interaction with direct oral anticoagulants: help from the laboratory for the personalized management of oral anticoagulant therapy. J Thromb Thrombolysis 48, 528–531 (2019). https://doi.org/10.1007/s11239-019-01866-1

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  • DOI: https://doi.org/10.1007/s11239-019-01866-1

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