Patients taking direct-acting oral anticoagulants (DOACs) such as apixaban may be at risk for adverse events such as major bleeding if they take over-the-counter (OTC) products (OTC medications and dietary supplements) that may interact with apixaban.
This study seeks to determine the prevalence of OTC product use among patients taking apixaban.
Secondary analysis of data from a 2017 Epic-based electronic health record data search that identified patients in the UCLA healthcare system who took apixaban in the past year.
Of 505 patient records reviewed, 254 (50.3%) had medical record documentation of OTC product use while on apixaban; these patients took a mean of 2.2 (SD=1.7) OTC products (range 1-12). Hispanic and African-American apixaban patients were significantly more likely than White patients to have documented OTC product use (68.3% and 71.9%, respectively, compared to 45.9%; p<0.01). 163 (32.3%) of all patients took products with potential interactions with apixaban. Products with potential major interactions with apixaban, such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDS), were taken by 92 (18.2%) and 28 (5.5%) patients, respectively. Eleven (2.2%) took omega-3 fatty acids /fish oil (moderate potential interaction), and 57 (11.3%) took other dietary supplements with minor potential interactions with apixaban. There were no significant differences in OTC product use in patients with and without a prior history of warfarin use.
EHR data indicate that almost 1 in 3 of all apixaban patients took OTC products with potential apixaban interactions. Regardless of prior history of anticoagulant use, educational efforts targeting apixaban patients should focus on conveying the potential for interactions between apixaban and common OTC products.