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Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation

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Abstract
Background: Evidence and guidelines for Non-vitamin K antagonist oral anticoagulants (NOACs) use when prescribing concurrent rifampin for tuberculosis treatment in patients with non-valvular atrial fibrillation (NVAF) are limited.

Methods: Using the Korean National Health Insurance Service database from January 2009 to December 2018, we performed a population-based retrospective cohort study to assess the net adverse clinical events (NACE), a composite of ischemic stroke or systemic embolism and major bleeding, of NOACs compared with warfarin among NVAF patients taking concurrent rifampin administration for tuberculosis treatment. After a propensity matching score (PSM) analysis, Cox proportional hazards regression was performed in matched cohorts to investigate the clinical outcomes.

Results: Of the 735 consecutive patients selected, 465 (63.3%) received warfarin and 270 (36.7%) received NOACs. Among 254 pairs of patients after PSM, the crude incidence rate of NACE was 25.6 in NOAC group and 32.8 per 100 person-years in warfarin group. There was no significant difference between NOAC and warfarin use in NACE (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.48-1.14; P = 0.172). Major bleeding was the main driver of NACE, and NOAC use was associated with a statistically significantly lower risk of major bleeding than that with warfarin use (HR, 0.63; 95% CI, 0.40-1.00; P = 0.0499).

Conclusions: In our population-based study, there was no statically significant difference in the occurrence of NACE between NOAC and warfarin use. NOAC use may be associated with a lower risk of major bleeding than that with warfarin use.
Author(s)
Ki Won HwangJin Hee ChoiSoo Yong LeeSang Hyun LeeMin Ku ChonJungkuk LeeHasung KimYong-Giun KimHyung Oh ChoiJeong Su KimYong-Hyun ParkJune Hong KimKook Jin ChunGi-Byoung NamKee-Joon Choi
Issued Date
2023
Type
Article
Keyword
AnticoagulationAtrial fibrillationDrug-drug interactionsRifampinTuberculosis
DOI
10.1186/s12872-023-03212-z
URI
https://oak.ulsan.ac.kr/handle/2021.oak/17121
Publisher
BMC Cardiovascular Disorders
Language
영어
ISSN
1471-2261
Citation Volume
23
Citation Number
1
Citation Start Page
1
Citation End Page
11
Appears in Collections:
Medicine > Nursing
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