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Utilization of Direct Oral Anticoagulants in People with HIV: Observational Data from the DC Cohort

  1. Author:
    George, Jomy M
    Kuriakose,Safia
    Monroe, Anne
    Hou, Qingjiang
    Byrne, Morgan
    Pau, Alice K
    Masur, Henry
    Hadigan, Colleen
    Castel, Amanda D
    Horberg, Michael A

  2. Author Address

    Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, MD, USA., Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA., Milken Institute School of Public Health, George Washington University, Washington, DC, USA., Population Health-Research, Cerner Corporation, Kansas City, MO, USA., National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA., Clinical Center Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA., Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.,
    1. Year: 2020
    2. Date: Dec 17
    3. Epub Date: 2020 03 17
  2. Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
    1. 71
    2. 10
    3. Pages: E604-E613
  4. Type of Article: Article
  5. ISSN: 1058-4838
  1. Abstract:

    Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people with HIV (PWH) are not well described. Co-administration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic interactions. A longitudinal cohort study was conducted using the DC Cohort Database in Washington, D.C., from January 2011-March 2017, to describe oral anticoagulant prescribing among PWH = 18 years old and the prevalence of DOAC use with RTV or COBI. Data collection included demographic and clinical characteristics, ARV and anticoagulant prescriptions and ICD-9/10 diagnosis codes. Among 8,315 PWH, there were 236 anticoagulant prescriptions (96 DOAC, 140 warfarin) for 206 persons. PWH prescribed anticoagulants were predominantly Black (82%), male (82%), with a median age at anticoagulant initiation of 56 years. DOAC use increased from 3% of total anticoagulant prescribing in 2011 to 43% in 2016, accounting for 64% of all newly recorded anticoagulant prescriptions by 2016. Nineteen bleeding events were recorded among 16 individuals. Despite the FDA label recommendation to avoid rivaroxaban with boosted ARVs, 41% remained on boosted ARVs after rivaroxaban initiation. DOAC use increased substantially in PWH by 2016. Although rivaroxaban is not recommended with RTV or COBI, concomitant use was recorded in 41% of rivaroxaban recipients in this cohort. As DOAC usage increases, clinicians need to be aware of potential DOAC-ARV interactions in order to select the most appropriate oral anticoagulant and monitoring plan for PWH. Published by Oxford University Press for the Infectious Diseases Society of America 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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External Sources

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  2. DOI: 10.1093/cid/ciaa284
  3. PMID: 32179901
  4. View record in Web of Science®
  5. WOS: 000606534600009
  6. PII : 5808710

Library Notes

  1. Fiscal Year: FY2019-2020
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