Drug-drug interactions between vitamin K antagonists and statins: a systematic review

Anna E Engell; Andreas L O Svendsen; Bent S Lind; Tore Bjerregaard Stage; Maja Hellfritzsch; Anton Pottegård

doi:10.1007/s00228-020-03074-w

Drug-drug interactions between vitamin K antagonists and statins: a systematic review

Anna E Engell, Andreas L O Svendsen, Bent S Lind, Tore Bjerregaard Stage, Maja Hellfritzsch, Anton Pottegård

Klinisk Biokemisk Afdeling

2 Citationer (Scopus)

Abstract

PURPOSE: Concomitant use of vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review to evaluate the effect of statin initiation on coagulation among VKA users.

METHODS: Following the PRISMA guidelines, we applied two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed; 8623 unique hits were obtained. In the final sample, eight studies were included.

RESULTS: The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65.

CONCLUSION: The anticoagulant effect of statin initiation in patients treated with VKA is likely to be of limited clinical relevance but should be evaluated individually.

Originalsprog	Engelsk
Tidsskrift	European Journal of Clinical Pharmacology
Vol/bind	77
Udgave nummer	10
Sider (fra-til)	1435-1441
Antal sider	7
ISSN	0031-6970
DOI	https://doi.org/10.1007/s00228-020-03074-w
Status	Udgivet - okt. 2021

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title = "Drug-drug interactions between vitamin K antagonists and statins: a systematic review",

abstract = "PURPOSE: Concomitant use of vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review to evaluate the effect of statin initiation on coagulation among VKA users.METHODS: Following the PRISMA guidelines, we applied two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed; 8623 unique hits were obtained. In the final sample, eight studies were included.RESULTS: The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65.CONCLUSION: The anticoagulant effect of statin initiation in patients treated with VKA is likely to be of limited clinical relevance but should be evaluated individually.",

keywords = "Anticoagulants, Drug interactions, Statins, Vitamin K antagonists, Warfarin",

author = "Engell, {Anna E} and Svendsen, {Andreas L O} and Lind, {Bent S} and Stage, {Tore Bjerregaard} and Maja Hellfritzsch and Anton Potteg{\aa}rd",

note = "Publisher Copyright: {\textcopyright} 2020, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

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doi = "10.1007/s00228-020-03074-w",

language = "English",

volume = "77",

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TY - JOUR

T1 - Drug-drug interactions between vitamin K antagonists and statins

T2 - a systematic review

AU - Engell, Anna E

AU - Svendsen, Andreas L O

AU - Lind, Bent S

AU - Stage, Tore Bjerregaard

AU - Hellfritzsch, Maja

AU - Pottegård, Anton

PY - 2021/10

Y1 - 2021/10

N2 - PURPOSE: Concomitant use of vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review to evaluate the effect of statin initiation on coagulation among VKA users.METHODS: Following the PRISMA guidelines, we applied two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed; 8623 unique hits were obtained. In the final sample, eight studies were included.RESULTS: The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65.CONCLUSION: The anticoagulant effect of statin initiation in patients treated with VKA is likely to be of limited clinical relevance but should be evaluated individually.

AB - PURPOSE: Concomitant use of vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review to evaluate the effect of statin initiation on coagulation among VKA users.METHODS: Following the PRISMA guidelines, we applied two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed; 8623 unique hits were obtained. In the final sample, eight studies were included.RESULTS: The most frequently used VKA in the studies was warfarin, while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean international normalized ratio (INR) ranged from 0.15-0.65.CONCLUSION: The anticoagulant effect of statin initiation in patients treated with VKA is likely to be of limited clinical relevance but should be evaluated individually.

KW - Anticoagulants

KW - Drug interactions

KW - Statins

KW - Vitamin K antagonists

KW - Warfarin

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U2 - 10.1007/s00228-020-03074-w

DO - 10.1007/s00228-020-03074-w

M3 - Review

C2 - 33895864

SN - 0031-6970

VL - 77

SP - 1435

EP - 1441

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

IS - 10

ER -

Drug-drug interactions between vitamin K antagonists and statins: a systematic review

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