Direct Oral Anticoagulants and Concomitant Anti-seizure Medications: A Retrospective, Case-Control Study in a...

Area of Science:

• Pharmacology
• Neurology
• Clinical Medicine

Background:

• Direct oral anticoagulants (DOACs) are increasingly prescribed for patients with epilepsy on anti-seizure medications (ASMs).
• Guidelines recommend caution due to potential pharmacologic interactions, but clinical evidence is limited.
• Real-world data on the safety and efficacy of DOAC-ASM co-therapy is scarce.

Purpose of the Study:

• To assess the frequency of ischemic/hemorrhagic events and epileptic seizures in patients using DOAC-ASM co-therapy.
• To compare outcomes of DOAC-ASM co-therapy with DOAC monotherapy and ASM monotherapy.
• To evaluate the clinical relevance of potential drug interactions between DOACs and ASMs.

Main Methods:

• A retrospective case-control study design.
• Inclusion of 124 patients on concomitant DOAC and ASM (valproic acid or levetiracetam) therapy for at least 6 months.
• Comparison with age- and gender-matched DOAC-control and ASM-control groups using data from electronic health records.

Main Results:

• The DOAC-ASM co-therapy group experienced 1.6% ischemic and 1.6% major hemorrhagic events.
• The DOAC-control group had 3.2% ischemic events and no hemorrhagic events.
• No statistically significant differences were found in ischemic/hemorrhagic events between the co-therapy and DOAC-control groups, nor in seizure recurrence rates compared to the ASM-control group.

Conclusions:

• Concomitant use of levetiracetam or valproic acid with DOACs did not significantly increase the risk of adverse events in a real-world clinical setting.
• Findings suggest that DOACs can be safely co-administered with these specific ASMs.
• Further research with larger sample sizes is warranted to confirm these results.