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 The study focused on 791 patients prescribed apixaban, one of
several newer blood thinners known as NOACs (non-vitamin K
antagonist oral anticoagulants) that are recommended to prevent
stroke in people with atrial fibrillation, a heart rhythm disorder.
Almost all of these patients used over-the-counter medicines, and
33% of them took at least one nonprescription drug daily or most
days of the week with the potential to cause dangerous side effects
when combined with apixaban. And almost 7% of them regularly took
two or more over-the-counter medicines that could be a dangerous mix
with apixaban.
"New OTC products are constantly being adopted by patients," Dr.
Derjung Tarn of the David Geffen School of Medicine at UCLA and
colleagues write in the Journal of the American Geriatrics Society.
"This study demonstrates that patients have limited knowledge about
potential serious interactions between OTC products and apixaban."
In atrial fibrillation, electrical impulses in the upper chambers of
the heart are chaotic, causing the heart muscle to quiver rather
than contracting normally. As a result, blood doesn't flow smoothly
through the heart. This can lead to the formation of clots that can
then travel through the arteries to the brain.
NOACs are the drug of choice for stroke prevention in patients with
atrial fibrillation, which occurs most frequently in older patients.
Apixaban is one of the most frequently prescribed. Others include
dabigatran, rivaroxaban, and edoxaban.
Unlike the older blood-thinner warfarin, which required regular
blood tests to prevent side effects, most people prescribed apixaban
or other NOACs are not followed in specialized anticoagulation
clinics or monthly by health care professionals, the study team
writes. As a result, they may not be aware of potential drug
interactions.
In the current study, researchers surveyed patients prescribed
apixaban in 2018. They asked patients how often they took
over-the-counter remedies like aspirin, ibuprofen, naproxen, and
acetaminophen. They also asked about common dietary supplements,
including Chinese herbs, various fish oils, ginger and herbal teas.
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Aspirin was the most commonly used nonprescription treatment in the
study, and almost two-thirds of people on aspirin also took at least
one other over-the-counter medicine with the potential to increase
the risk of bleeding when mixed with apixaban.
The study didn't look at whether mixing over-the-counter medicines
or supplements with blood thinners actually caused bleeding or other
dangerous side effects in these patients.
One limitation of the analysis is that researchers relied on
patients to accurately recall and report on what over-the-counter
medicines and supplements they used.
It's also not clear from the study whether people started using any
of these nonprescription remedies before or after they were
prescribed apixaban.
"Patients who have taken OTC medications or dietary supplements
without any problems prior to starting apixaban may not consider
potential interactions, particularly if they ingest the supplements
as part of their diet," the study team writes.
"For example, certain ethnic groups may regularly incorporate
dietary supplements, such as turmeric and Chinese herbs, in their
meals," the study team notes. "Unless providers ask them, patients
may not realize these are important to disclose."
SOURCE: http://bit.ly/36aNTHG Journal of the American Geriatrics
Society, online October 28, 2019.
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