Moderate-strong CYP3A4 or Pgp inhibitors and inducers alter direct oral anticoagulant (DOAC) pharmacokinetics. Whether the presence of a DOAC drug-drug interaction (DDI) prompts in- hospital changes in management remains unknown. We identified all hospitalized patients at our institution who were admitted with a clinically relevant DOAC DDI from 01/2021 to 06/2021. Clinically relevant DOAC DDIs were defined as those listed in the prescribing information or FDA CYP3A4/Pgp inhibitors clinical indexes. We assessed the prevalence of DOAC DDIs and categorized their management as: drug stopped, drug held, or drug continued. For drugs that were continued we assessed whether the dose of the DOAC or interacting drug was increased, decreased or unchanged during the admission. We ascertained the number of DOAC DDIs that prompted an automated prescribing alert in our electronic health record (EHR). Finally, we conducted a logistic regression model to compare users of DOACs with DDI who had their regimen adjusted versus those without adjustments, focusing on outcomes of rehospitalization and death, adjusting for age and gender. Among 3,725 hospitalizations with a DOAC admission order, 197 (5%) had a clinically relevant DOAC DDI. The DOAC and the interacting drug were continued at discharge for 124 (63%) hospitalizations. The most frequent adjustments were stopping the interacting drug (73%) and stopping the DOAC (15%). Only 7 (4%) of DOAC DDIs prompted an EHR alert. The adjusted odds ratios for rehospitalizations and death, respectively, among patients whose regimens were adjusted compared to those whose were not, were 1.29 (95% CI, 0.67 to 2.48; P = 0.44) and 1.88 (95% CI, 0.91 to 3.89; P = 0.09). Clinically relevant DDIs with DOACs occur infrequently among hospitalized patients and usually are managed without stopping the DOAC. The clinical impact of such DDIs and subsequent adjustments on thrombotic and hemorrhagic outcomes requires further investigation.

中强 CYP3A4 或 Pgp 抑制剂和诱导剂会改变直接口服抗凝剂 (DOAC) 的药代动力学。 DOAC 药物相互作用 (DDI) 的存在是否会促使院内管理发生变化仍不清楚。我们确定了我们机构 2021 年 1 月至 2021 年 6 月期间因临床相关 DOAC DDI 入院的所有住院患者。临床相关的 DOAC DDI 被定义为处方信息或 FDA CYP3A4/Pgp 抑制剂临床指标中列出的那些。我们评估了 DOAC DDI 的患病率，并将其管理分为：停止用药、暂停用药或继续用药。对于继续使用的药物，我们评估了入院期间 DOAC 或相互作用药物的剂量是否增加、减少或不变。我们确定了在我们的电子健康记录 (EHR) 中触发自动处方警报的 DOAC DDI 数量。最后，我们建立了一个逻辑回归模型来比较接受 DOAC 和 DDI 治疗方案的用户与未调整治疗方案的用户，重点关注再住院和死亡的结果，并根据年龄和性别进行调整。在 3,725 例有 DOAC 入院令的住院患者中，197 例 (5%) 有临床相关的 DOAC DDI。 124 例 (63%) 住院患者出院时继续使用 DOAC 和相互作用的药物。最常见的调整是停止相互作用的药物（73%）和停止 DOAC（15%）。只有 7 (4%) 的 DOAC DDI 提示了 EHR 警报。与未调整治疗方案的患者相比，调整后的再住院和死亡比值比分别为 1.29（95% CI，0.67 至 2.48；P  = 0.44）和 1.88（95% CI，0.91 至 3.89；P = 0.44）。P  = 0.09）。与 DOAC 相关的临床相关 DDI 在住院患者中很少发生，并且通常在不停止 DOAC 的情况下进行治疗。此类 DDI 的临床影响以及随后对血栓和出血结果的调整需要进一步研究。