Potential Drug Interaction on Bleeding Events in Stroke Recurrence Patients with Atrial Fibrillation
DOI:
https://doi.org/10.33096/gmj.v6i2.185Kata Kunci:
Drug interaction, bleeding, stroke, atrial fibrillationAbstrak
Introduction: Stroke is a major complication of atrial fibrillation, carries a high risk of recurrence. The likelihood of adverse effects from warfarin-drug interactions increases with the number of concurrent medications. Identifying these potential interactions is crucial. This study aimed to evaluate the impact of drug interactions on bleeding events and the incidence of recurrent stroke in patients with atrial fibrillation.
Methods: This retrospective study tracked 314 stroke patients with atrial fibrillation at Dr. Sardjito and Dr. Moewardi General Hospital over one year who received warfarin at two hospitals from January 2015 to December 2019. Using purposive sampling, 50 patients were analyzed and divided into two groups, 11 with stroke recurrence and 39 without recurrence in one year of treatment. Statistical analyses, including chi-square tests and odds ratio calculations, were performed to assess factors influencing stroke recurrence.
Results: In addition, major, moderate, and minor drug interactions were not significantly different p>0,05. Meanwhile, minor drug interaction correlated with bleeding event (p<0,05) and OR 0,1. The study underscored an elevated risk of bleeding associated with combinations such as warfarin-amiodarone, warfarin-clopidogrel, and various NSAIDs in major interaction analysis.
Conclusion: The research highlights an increased risk of bleeding caused by interaction in combinations therapiest such as warfarin-amiodarone, warfarin-clopidogrel, and various NSAIDs. These findings stress the importance of careful evaluation and management of drug interactions to reduce adverse effects and enhance outcomes for patients with recurrent strokes with atrial fibrillation.
Referensi
Bhagavathula AS, Berhanie A, Tigistu H, Abraham Y, Getachew Y, Khan TM, et al. Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia. Asian Pac J Trop Biomed. 2014;4(Suppl 1):S204–8.
Caratozzolo S, Gipponi S, Marengoni A, Pari E, Scalvini A, Pasina L, et al. Potentially serious drug-drug interactions in older patients hospitalized for acute ischemic and hemorrhagic stroke. Eur Neurol. 2016;76(3–4):161–6.
Venkateswaramurthy N, Krishnaveni K, Mercy Freeda R, Sambath KR. Assessment of potential drug–drug interaction in stroke patients. Drugs. 2016;175:85–7.
Aleksic DZ, Jankovic SM, Mlosavljevic MN, Toncev GL, Miletic Drakulic SD, Stefanovic SM. Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit. Open Med. 2019;14(1):813–26.
Otite FO, Khandelwal P, Chaturvedi S, Romano JG, Sacco RL, Malik AM. Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA. Neurology. 2016;87(19):2034–42.
John Camm A, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33(21):2719–47.
Seiffge DJ, Cancelloni V, Räber L, Paciaroni M, Metzner A, Kirchhof P, et al. Secondary stroke prevention in people with atrial fibrillation: treatments and trials. Lancet Neurol. 2024;23(4):404–17.
Indonesia PDSK. Pedoman tata laksana fibrilasi atrium. Cent Commun. 2014;
Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy - Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 SUPPL.):e44S-e88S.
G. T, N. S, B. L, M.L. B. Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: A prospective observational study. Thromb J [Internet]. 2014;12(1):1–8.
Rikala M, Hauta-Aho M, Helin-Salmivaara A, Lassila R, Korhonen MJ, Huupponen R. Co-Prescribing of Potentially Interacting Drugs during Warfarin Therapy - A Population-Based Register Study. Basic Clin Pharmacol Toxicol. 2015 Aug;117(2):126–32.
Nilamsari WP, Yusuf M, Pertiwi DA, Dery A, Budi S, Zulkarnaen B. Study of co-prescription of drugs potentially interacting with warfarin in indonesian ambulatory patients. Res J Pharm Technol. 2020;13(8):3833–6.
Lu Y, Shen D, Pietsch M, Nagar C, Fadli Z, Huang H, et al. A novel algorithm for analyzing drug-drug interactions from MEDLINE literature. Sci Rep [Internet]. 2015;5:1–10. Available from: http://dx.doi.org/10.1038/srep17357
Kent AP, Brueckmann M, Fraessdorf M, Connolly SJ, Yusuf S, Eikelboom JW, et al. Concomitant Oral Anticoagulant and Nonsteroidal Anti-Inflammatory Drug Therapy in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2018 Jul;72(3):255–67.
Sindi BZ, Albahrani AM, Azrai MM, Harbi S Al, Hussain A, Jassem A, et al. Inflammatory Drugs ( Nsaids ) With Warfarin. 2018;05(12):17050–5.
Dalgaard F, Mulder H, Wojdyla DM, Lopes RD, Held C, Alexander JH, et al. Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial. Circulation. 2020;141(1):10–20.
Hamadouk RM, Alshareif EM, Hamad HM, Yousef BA. The Prevalence and Severity of Potential Drug–Drug Interactions in Internal Medicine Ward at Soba Teaching Hospital. Drug Healthc Patient Saf. 2023;15(October):149–57.
Wu J, Zhang Y, Liao X, Lei Y. Anticoagulation Therapy for Non-valvular Atrial Fibrillation: A Mini-Review. Front Med. 2020;7(July):1–6.
Fitzgerald P, Stancampiano F, Kurklinsky A, Nikpour N, McLeod E, Li Z, et al. Warfarin therapy in atrial fibrillation: assessment of patient knowledge of risks and benefits. J Community Hosp Intern Med Perspect. 2020;10(3):179–87.
