title: Old and new oral anticoagulants: Food, herbal medicines and drug interactions.
abstract: The most commonly prescribed oral anticoagulants worldwide are the vitamin K antagonists (VKAs) such as warfarin. Factors affecting the pharmacokinetics of VKAs are important because deviations from their narrow therapeutic window can result in bleedings due to over-anticoagulation or thrombosis because of under-anticoagulation. In addition to pharmacodynamic interactions (e.g., augmented bleeding risk for concomitant use of NSAIDs), interactions with drugs, foods, herbs, and over-the-counter medications may affect the risk/benefit ratio of VKAs. Direct oral anticoagulants (DOACs) including Factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and thrombin inhibitor (dabigatran) are poised to replace warfarin. Phase-3 studies and real-world evaluations have established that the safety profile of DOACs is superior to those of VKAs. However, some pharmacokinetic and pharmacodynamic interactions are expected. Herein we present a critical review of VKAs and DOACs with focus on their potential for interactions with drugs, foods, herbs and over-the-counter medications.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: alessandro.diminno@ccfm.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Minno
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: beatrice.frigerio@ccfm.it.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Frigerio
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy. Electronic address: spadarellagaia@hotmail.it.
authors.forename: Gaia
authors.initials: G
authors.lastname: Spadarella
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: alessio.ravani@ccfm.it.
authors.forename: Alessio
authors.initials: A
authors.lastname: Ravani
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: daniela.sansaro@ccfm.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sansaro
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: mauro.amato@ccfm.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Amato
authors.affiliation: College of Medicine, The Ohio State University, Columbus, OH, USA. Electronic address: joseph.kitzmiller@osumc.edu.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Kitzmiller
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: mauro.pepi@ccfm.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy. Electronic address: elena.tremoli@ccfm.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy. Electronic address: damiano.baldassarre@unimi.it.
authors.forename: Damiano
authors.initials: D
authors.lastname: Baldassarre
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D004347:Drug Interactions; D018565:Food-Drug Interactions; D029001:Herbal Medicine / Q000379:methods; D006801:Humans; D010936:Plant Extracts / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D010946:Plants, Medicinal / Q000737:chemistry; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D010936:Plant Extracts; D014812:Vitamin K
keywords: Co-morbidities; Direct anticoagulant drugs; Loss of efficacy; Patients characteristics; Therapeutic context; Thrombotic/bleeding events; Toxicity; Warfarin