Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation

• Published in: BMC cardiovascular disorders Vol. 23; no. 1; pp. 182 - 11
• Main Authors: Hwang, Ki Won, Choi, Jin Hee, Lee, Soo Yong, Lee, Sang Hyun, Chon, Min Ku, Lee, Jungkuk, Kim, Hasung, Kim, Yong-Giun, Choi, Hyung Oh, Kim, Jeong Su, Park, Yong-Hyun, Kim, June Hong, Chun, Kook Jin, Nam, Gi-Byoung, Choi, Kee-Joon
• Format: Journal Article
• Language: English
• Published: London BioMed Central 04.04.2023; BioMed Central Ltd; BMC
• Subjects: Administration, Oral; Angiology; Anticoagulants; Anticoagulants (Medicine); Anticoagulation; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Bleeding; Blood Transfusion Medicine; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Care and treatment; Case reports; Chronic obstructive pulmonary disease; Comorbidity; Complications and side effects; Demographic aspects; Diabetes; Diagnosis; Dosage and administration; Drug interactions; Drug withdrawal; Drug-drug interactions; Embolism; Embolisms; Enzymes; Fibrillation; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Hospitalization; Humans; Hypertension; Internal Medicine; Ischemia; Laboratories; Management; Medical screening; Medicine; Medicine & Public Health; Metabolic disorders; National health insurance; Patients; Performance evaluation; Population; Population studies; Regression analysis; Retrospective Studies; Rifampin; Rifampin - adverse effects; Rivaroxaban - adverse effects; Sensitivity analysis; Stroke; Stroke - diagnosis; Stroke - epidemiology; Stroke - prevention & control; Thromboembolism; Thrombosis; Tuberculosis; Tuberculosis - chemically induced; Tuberculosis - complications; Tuberculosis - drug therapy; Vitamin K; Warfarin; South Korea; Anticoagulation; Drug-drug interactions; Tuberculosis; Rifampin; Atrial fibrillation
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-023-03212-z

Background Evidence and guidelines for Non-vitamin K antagonist oral anticoagulants (NOACs) use when prescribing concurrent rifampin for tuberculosis treatment in patients with non-valvular atrial fibrillation (NVAF) are limited. Methods Using the Korean National Health Insurance Service database from January 2009 to December 2018, we performed a population-based retrospective cohort study to assess the net adverse clinical events (NACE), a composite of ischemic stroke or systemic embolism and major bleeding, of NOACs compared with warfarin among NVAF patients taking concurrent rifampin administration for tuberculosis treatment. After a propensity matching score (PSM) analysis, Cox proportional hazards regression was performed in matched cohorts to investigate the clinical outcomes. Results Of the 735 consecutive patients selected, 465 (63.3%) received warfarin and 270 (36.7%) received NOACs. Among 254 pairs of patients after PSM, the crude incidence rate of NACE was 25.6 in NOAC group and 32.8 per 100 person-years in warfarin group. There was no significant difference between NOAC and warfarin use in NACE (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.48–1.14; P  = 0.172). Major bleeding was the main driver of NACE, and NOAC use was associated with a statistically significantly lower risk of major bleeding than that with warfarin use (HR, 0.63; 95% CI, 0.40–1.00; P  = 0.0499). Conclusions In our population-based study, there was no statically significant difference in the occurrence of NACE between NOAC and warfarin use. NOAC use may be associated with a lower risk of major bleeding than that with warfarin use.