Title:Is Anticoagulation with Novel Oral Anticoagulants an Effective Treatment for Tuberculosis Patients not Achieving a Therapeutic Range with Vitamin K Antagonists? A Systematic Review
Volume: 17
Issue: 2
Author(s): Marco Fiore*, Alberto Enrico Maraolo, Paolo Chiodini, Claudio Cerchione, Ivan Gentile, Guglielmo Borgia and Maria Caterina Pace
Affiliation:
- Department of Anaesthesiological, Surgical & Emergency Sciences, University of Campania “Luigi Vanvitelli”, 80138, Naples,Italy
Keywords:
Novel direct oral anticoagulants, antitubercular therapy, antimicrobials, tuberculosis, venous thromboembolic
events, systematic review.
Abstract: Background: Approximately 3% of Tuberculosis (TB) patients have a venous thromboembolic
events (VTE). The use of Vitamin K antagonists (VKAs), as anticoagulant, in patients
receiving anti TB antimicrobials is often complicated by drug interactions, especially with rifampicin.
These patients require frequent monitoring of the International Normalized Ratio (INR), and
it is reported that warfarin can not achieve a therapeutic INR. In such cases, abruptly stopping the
rifampicin once the course of anti TB antimicrobials is not completed is potentially hazardous. The
most recent alternative to prevent thrombotic episodes by using oral agents is represented by novel
oral anticoagulants (NOAs) an important breakthrough since they do not require strict laboratory
monitoring, frequent dosing adjustments, or dietary restrictions; moreover, they and they are linked
with far fewer drug-drug interactions.
Objective: We have performed a Systematic Review to retrieve information about studies that have
assessed the effect of NOAs administered in combination with anti TB antimicrobials in order to
investigate if NOAs could be used in TB patients with VTE that do not achieve a therapeutic INR
with VKAs.
Method: The MEDLINE and Google Scholar databases were screened from the inception to 5th
of February 2017, using two search strategies: the first one was antimicrobials AND novel oral
anticoagulants; the second was antibiotics AND novel oral anticoagulants.
Results: 1011 titles were identified on PubMed and Google Scholar published from the inception to
February 5, 2017, of these 17 studies were included in the qualitative synthesis
Conclusion: No published data were found that properly assessed the effect of NOAs administered
in combination with anti TB antimicrobials. Further studies are needed to establish the safety of
NOAs in this clinical scenario. In the meanwhile, a viable alternative to VKAs, in order to prevent
complications of VTE related to TB, may be represented by Low Molecular Weight Heparin
(LMWH), notwithstanding the limitation of the parental route of administration.
