Non-vitamin K Antagonist Oral Anticoagulants and Drug-Food Interactions: Implications for Clinical Practice and Potential Role of Probiotics and Prebiotics.

José Miguel Rivera-Caravaca,Francisco Marín,Raquel López-Gálvez,Vanessa Roldán,Ana Sánchez-Fuentes

doi:10.3389/fcvm.2021.787235

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) are a therapeutic option to prevent stroke in patients with atrial fibrillation (AF). In fact, NOACs have become the recommended choice by international clinical practice guidelines over vitamin K antagonists (VKA), because of their efficacy and safety profile, especially in newly initiated patients. The more predictable pharmacokinetic and pharmacodynamic profile of this family of drugs allows preventing anticoagulation drug monitoring. Furthermore, NOACs have significantly fewer drug and food interactions in comparison with VKAs. Despite this, there are no studies that compare the effects on the quality of anticoagulation of NOACs with the intake of potential interactions drugs of P-glycoprotein and cytochrome P450 (CYP). This review brings an overview of NOACs pharmacokinetics profile and their potential drug-food interactions. We also briefly discuss the potential role of prebiotics and probiotics in patients under therapy with NOACs.

Highlights

Non-vitamin K antagonist oral anticoagulants (NOACs), including rivaroxaban, apixaban and edoxaban as factor Xa inhibitors, and dabigatran etexilate as a thrombin inhibitor, are the firstline treatment for most patients with venous thromboembolism (VTE) and for stroke prevention in atrial fibrillation (AF) [1,2,3].It is well known that NOACs have a lower propensity for drug and food interactions compared to vitamin K antagonists (VKAs), due to their individual coagulation proteins target and to the administration in fixed-dose without requiring routine coagulation monitoring [4]
Variations in NOACs concentration may occur with the concomitant use of inducers or inhibitors of P-glycoprotein (P-gp) and cytochrome P450 (CYP) 3A4, increasing thrombotic and bleeding risk, respectively [5,6,7,8]
The use of probiotics and prebiotics is currently increasing due to their multiple benefits described in the human body, but it is unclear whether probiotics and prebiotics might have a potential influence on NOACs pharmacokinetic parameters [9]

Summary

INTRODUCTION

Non-vitamin K antagonist oral anticoagulants (NOACs), including rivaroxaban, apixaban and edoxaban as factor Xa inhibitors, and dabigatran etexilate as a thrombin inhibitor, are the firstline treatment for most patients with venous thromboembolism (VTE) and for stroke prevention in atrial fibrillation (AF) [1,2,3]. There is scarce evidence about the potential interactions of herbal products, dietary supplements, and food with NOACs. the use of probiotics and prebiotics is currently increasing due to their multiple benefits described in the human body, but it is unclear whether probiotics and prebiotics might have a potential influence on NOACs pharmacokinetic parameters [9]. The use of probiotics and prebiotics is currently increasing due to their multiple benefits described in the human body, but it is unclear whether probiotics and prebiotics might have a potential influence on NOACs pharmacokinetic parameters [9] The aim of this mini-review article is to summarize the present knowledge on potential drugfood/herbal products interactions of NOACs and the potential implications of increased use of products such as probiotics and prebiotics

Brief Summary of the NOACs Pharmacology

No effect

Effect of Food and Herbal Products on the NOACs Pharmacology

Plants from Traditional Chinese

CONCLUSIONS

Findings

AUTHOR CONTRIBUTIONS