Safety and efficacy of concomitant treatment with non-vitamin K antagonist oral anticoagulants and antiseizure medications: A propensity score matching cohort study.
Michela GiustozziCarmen CalvelloPaolo EusebiFederico Paolini PaolettiGiorgio SilvestrelliMatteo MazzettiMarialuisa SillaAlessia BellottiMaria Cristina VedovatiCecilia BecattiniMichele RomoliLucilla ParnettiMaurizio PaciaroniCinzia CostaPublished in: Epilepsia (2024)
Research on cerebrovascular events in atrial fibrillation (AF) patients taking non-vitamin K antagonist oral anticoagulants (NOACs) with antiseizure medications (ASMs) is limited, highlighting a significant gap in literature. We assessed thrombotic and hemorrhagic risks in patients on NOACs and ASMs versus those on NOACs or ASMs alone. We analyzed a retrospective cohort from five centers, including AF and epilepsy patients on both medications (n = 188), AF patients on NOACs (n = 298), and epilepsy patients on ASMs (n = 50), with a 3-year follow-up. Propensity score matching adjusted for cardiovascular risk differences. The primary outcomes were ischemic stroke, transient ischemic attack, and major bleeding. Results showed the ASM+NOAC group had a higher risk of primary outcomes compared to the NOAC-only group (5.68% vs. 1.18%, hazard ratio = 5.72, 95% confidence interval = 2.22-14.73), with no events in the ASM-only group. This suggests an increased risk for patients on combined NOAC and ASM therapy, underlining the need for careful drug interaction consideration.
Keyphrases
- atrial fibrillation
- oral anticoagulants
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- heart failure
- systematic review
- emergency department
- metabolic syndrome
- type diabetes
- oxidative stress
- acute coronary syndrome
- patient reported outcomes
- adipose tissue
- left atrial
- patient reported
- subarachnoid hemorrhage
- human health
- electronic health record
- temporal lobe epilepsy