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DOAC drug interactions and risk of major bleeding
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  • Published on: 27 April 2021
    Flawed methodology leading to flawed conclusion
    • Patricia Ging, Pharmacist Mater Misericordiae University Hospital , Dublin

    Dear D&T team,

    Thank you for highlighting this paper which attempts to answer an important clinical question.
    I read the DTB summary which reflects the published abstract and the authors' conclusions. Unfortunately this paper has a major flaw as the main CYP "interaction" seen in the study group and therefore studied was Atorvatsatin / Rivaroxaban .
    It has been well established that there is no clinically significant interaction between atorvastatin and rivaroxaban whatever the "clinical practice research database" might say.

    Therefore this study finds mainly that there is no interaction between two pairs of drugs that do not interact- atorvastatin and rivaroxaban and digoxin and rivaroxaban.
    The authors incorrectly extrapolates this finding to actual CYP 3a4 inhibitors although there is an exploratory finding of enhanced bleeding risk with these agents.
    In our busy world people may not have time to delve beyond the abstract and key points and may make an erroneous prescribing decision based on this.
    The finding related to SSRI use is very valuable and should be born in mind.

    Conflict of Interest:
    None declared.