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  • Washam, Jeffrey B.Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA (author)

Interacting medication use and the treatment effects of apixaban versus warfarin : results from the ARISTOTLE Trial

  • Article/chapterEnglish2019

Publisher, publication year, extent ...

  • 2019-02-21
  • SPRINGER,2019
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-382509
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-382509URI
  • https://doi.org/10.1007/s11239-019-01823-yDOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Warfarin is dependent on multiple hepatic enzymes for metabolism while apixaban is a substrate for P-glycoprotein (P-gp) transport and hepatic CYP3A4 metabolism. The aim of this analysis was to assess the impact of interacting medication use on the treatment effects of apixaban versus warfarin. Outcomes were compared between apixaban and warfarin using Cox proportional hazards modeling according to the use of interacting medications at randomization in ARISTOTLE (n=18,201). Interacting medications for apixaban were identified as combined P-gp and 3A4 inhibitors or inducers while interacting medications for warfarin were defined as those highly probable for warfarin potentiation or inhibition. At randomization, 5547 (30.5%) patients were on an interacting medication, including 2722 on apixaban and 2825 on warfarin. Patients using an interacting medication were more likely to be female, taking aspirin, and have a history of prior bleeding and were less likely to have a prior stroke or transient ischemic attack. No significant differences were observed on the treatment effect of apixaban compared with warfarin in patients on and off interacting medications for outcomes including the primary efficacy outcome of stroke or systemic embolism (P for interaction=0.79) or the primary safety outcome of major bleeding (P for interaction=0.75). Use of interacting medications with anticoagulants occurs often in patients with atrial fibrillation. Despite the potential for altered exposure, interacting medication use was not associated with a significant change in the efficacy or safety of apixaban compared with warfarin in the ARISTOTLE trial.Trial registration ClinicalTrials.gov, NCT00412984

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Hohnloser, Stefan H.Goethe Univ Frankfurt, Frankfurt, Germany (author)
  • Lopes, Renato D.Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA (author)
  • Wojdyla, Daniel M.Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA (author)
  • Vinereanu, DragosUniv & Emergency Hosp Bucharest, Bucharest, Romania (author)
  • Alexander, John H.Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA (author)
  • Gersh, Bernard J.Mayo Clin, Coll Med, Rochester, MN USA (author)
  • Hanna, MichaelBristol Myers Squibb Co, Princeton, NJ USA (author)
  • Horowitz, JohnUniv Adelaide, Basil Hetzel Inst, Queen Elizabeth Hosp, Adelaide, SA, Australia (author)
  • Hylek, Elaine M.Boston Univ, Sch Med, Boston, MA 02118 USA (author)
  • Xavier, DenisSt Johns Res Inst, Bengaluru, India (author)
  • Verheugt, Freek W. A.Univ Med Ctr Nijmegen, Nijmegen, Netherlands (author)
  • Wallentin, Lars,1943-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall (author)
  • Granger, Christopher B.Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA (author)
  • Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USAGoethe Univ Frankfurt, Frankfurt, Germany (creator_code:org_t)

Related titles

  • In:Journal of Thrombosis and Thrombolysis: SPRINGER47:3, s. 345-3520929-53051573-742X

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