Drug-drug interaction between warfarin and statins: A Danish cohort study.
Anna Elise EngellAndreas Ludvig Ohm SvendsenBent S LindChristen L AndersenJohn S AndersenTora G WilladsenFrederik PerssonJesper HallasPublished in: British journal of clinical pharmacology (2020)
Initiation of statin treatment is suggested to increase the international normalised ratio (INR) among warfarin users. However, available data is limited and conflicting. We conducted a register-based cohort study to evaluate the drug-drug interaction between warfarin and statins. By linking data on INR measurements and filled prescriptions, we identified warfarin users 2000-2015 initiating simvastatin (n = 1363), atorvastatin (n = 165) or rosuvastatin (n = 23). Simvastatin initiation led to an increase in mean INR from 2.40 to 2.71, with INRs peaking after 4 weeks, corresponding to a mean change of 0.32 (95%CI 0.25-0.38). High-dose and low-dose simvastatin led to comparable changes (mean change 0.33 vs 0.29). Initiation of atorvastatin and rosuvastatin lead to INR increases of 0.27 (95%CI 0.12-0.42) and 0.30 (95%CI -0.09-0.69). In conclusion, initiation of simvastatin, atorvastatin or rosuvastatin among warfarin users led to a minor increase in INR. The magnitude of this change is for most patients likely of limited clinical relevance.
Keyphrases
- atrial fibrillation
- direct oral anticoagulants
- venous thromboembolism
- low dose
- high dose
- oral anticoagulants
- cardiovascular disease
- end stage renal disease
- adverse drug
- newly diagnosed
- ejection fraction
- electronic health record
- coronary artery disease
- drug induced
- type diabetes
- big data
- emergency department
- prognostic factors
- stem cell transplantation
- data analysis
- smoking cessation
- low density lipoprotein