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Relevant pharmacologic interactions in the concurrent management of brain tumor-related epilepsy and venous thromboembolism: a systematic review

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Abstract

Introduction

Co-administration of direct oral anticoagulants (DOACs) with antiepileptic drugs (AEDs) is increasingly common in brain tumor patients. We therefore performed a systematic review of the current evidence for potential drug interactions between DOACs and AEDs in this patient population.

Methods

We conducted a systematic review of the literature via PubMed according to PRISMA guidelines (last accessed December 15, 2021). Included were clinical studies and case reports, written in English language and published between 2010 and 2021, that investigated concurrent clinical use of AEDs with DOACs for any indication. Non-English articles, articles not related to our research question, review articles and commentaries were excluded. Full-text articles were evaluated for possible confounding factors and results were summarized using a data table highlighting the key characteristics of each article.

Results

We identified a total of 122 unique articles, of which 27 were deemed relevant to our research question. Of these, 8 articles were clinical studies (n = 295,415 patients) and 19 were case reports (n = 25 patients). Only 3 clinical studies and 2 case reports reported interactions between AEDs and DOACs in patients with active cancer and none reported interactions in patients with brain tumors.

Conclusion

We have identified low (class IV) level evidence of potential drug interactions between DOACs and AEDs. Even though there is no current report of interactions in brain tumor patients, neuro-oncology providers should be aware of the emerging evidence regarding drug interactions between DOACs and AEDs and take this into consideration when concurrently prescribing these to patients.

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Change history

  • 09 April 2022

    The original version of this article has been revised: The 2nd author's name has been corrected.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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  1. Mayo Clinic Scottsdale: Mayo Clinic Arizona, Phoenix, AZ, USA

    David Gritsch

  2. Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    L. Nicolas Gonzalez Castro

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  1. David Gritsch
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DG performed the literature review, drafted the manuscript for intellectual content, and conceptualized and drafted the figure and tables. LNGC designed and conceptualized study and revised the manuscript for intellectual content.

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Correspondence to David Gritsch.

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Authors David Gritsch and L. Nicolas Gonzalez Castro declare they have no relevant financial or non-financial interests to disclose.

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Gritsch, D., Gonzalez Castro, L.N. Relevant pharmacologic interactions in the concurrent management of brain tumor-related epilepsy and venous thromboembolism: a systematic review. J Neurooncol 157, 285–296 (2022). https://doi.org/10.1007/s11060-022-03984-y

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