TOPLINE:

Direct oral anticoagulants (DOACs) prescribed by GPs in Belgium frequently involved drug-drug interactions (DDIs), with nearly 18% of prescriptions containing at least one DDI and these DDIs affecting more than 20% of patients with non-valvular atrial fibrillation (NVAF). More than 90% of the DDIs were pharmacodynamic in nature.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess the prevalence of DOAC-related DDIs in GP prescriptions and evaluate the factors associated with pharmacodynamic DDIs.
• They extracted data from a Belgian primary care database, including 5637 adults with NVAF (mean age, 77.0 years; 53.4% men) who received at least one DOAC prescription (rivaroxaban, apixaban, edoxaban, and dabigatran) from a GP between 2022 and 2023.
• DDIs were defined as the co-prescription of a DOAC and an interacting drug within the same calendar week.

TAKEAWAY:

• Overall, 22.9% of patients had at least one DDI during the year. Among 13,334 GP-issued DOAC prescriptions, 17.8% involved a DDI, and 91.5% of DDIs were pharmacodynamic.
• The most frequently interacting drug classes were selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (44.2%), antiplatelet agents (22.6%), and non-steroidal anti-inflammatory drugs (19.6%).
• A higher CHA2DS2-VASc score (adjusted odds ratio [aOR], 1.13; 95% CI, 1.06-1.20) and receiving multiple types of DOAC vs apixaban alone (aOR, 2.21; 95% CI, 1.12-4.24) were associated with increased odds of pharmacodynamic DDIs.
• Patients aged 65-74 years (aOR, 0.73; 95% CI, 0.57-0.93) and those aged 75-84 years (aOR, 0.64; 95% CI, 0.50-0.83) had lower odds of pharmacodynamic DDIs than those younger than 65 years; the use of edoxaban vs apixaban was also linked to lower odds (aOR, 0.70; 95% CI, 0.59-0.83).

IN PRACTICE:

"Prioritizing the identification and review of these high-risk associations may support safer anticoagulation prescribing in primary care," the authors wrote.

SOURCE:

The study was led by Victoria A. Fuchs of the Louvain Drug Research Institute at the Université catholique de Louvain in Brussels, Belgium. It was published online on May 21, 2026, in Scientific Reports.

LIMITATIONS:

Drug identification was based solely on GP prescription data, without verification of actual medication intake. Some patients may not have collected their prescriptions or followed the treatment plan. The study may have underestimated DDIs because data on prescriptions from specialists and over-the-counter medications were not available.

DISCLOSURES:

No funding was received for this study. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.