Direct oral anticoagulants in atrial fibrillation patients taking anti-tuberculosis medications

SESSION TITLE: Cardiovascular Disease Posters 6 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Anticoagulation in patients receiving anti-tuberculosis medications is often complicated by drug interactions, especially with rifampicin. The evidence regarding the effectiveness and safety of direct oral anticoagulants (DOACs) in patients taking anti-tuberculosis medications is lacking. The aim of this study was to compare DOACs with warfarin in atrial fibrillation (AF) patients taking anti-tuberculosis medications. METHODS: Using data from the Korean National Health Insurance Service database from January 2013 to December 2016, we evaluated 1,053 AF patients receiving anti-tuberculosis medications (isoniazid, ethambutol, rifampicin, and pyrazinamide) who were concomitantly treated with oral anticoagulants (397 with warfarin and 656 with DOACs). The study subjects were examined for stroke or systemic embolism, major bleeding, intracranial hemorrhage, gastrointestinal bleeding, and all-cause death. RESULTS: Patients with DOACs were older (76±8 vs. 74±10 years, p<0.001) and had a higher CHA2DS2-VASc score (5.4±1.7 vs. 5.1±2.1, p=0.011) than those with warfarin. However, DOACs were associated with lower risks for stroke or systemic embolism (hazard ratio [HR]: 0.418; 95% confidence interval [CI]: 0.281 to 0.623), major bleeding (HR: 0.653; 95% CI: 0.453 to 0.942), intracranial hemorrhage (HR: 0.667; 95% CI 0.301 to 1.476), gastrointestinal bleeding (HR: 0.578; 95% CI: 0.384 to 0.870), all-cause death (HR: 0.579; 95% CI: 0.443 to 0.759), and the composite outcome (HR: 0.640; 95% CI: 0.518 to 0.791) than warfarin. CONCLUSIONS: In AF patients receiving concomitant anti-tuberculosis medications, DOACs showed better effectiveness and safety than warfarin. Further studies are needed to establish the appropriate dose for DOACs in this clinical scenario. CLINICAL IMPLICATIONS: These findings suggest that clinicians should use anticoagulation with DOAC rather than warfarin during the treatment of tuberculosis in patients. DISCLOSURES: No relevant relationships by Jung-Hoon Sung No relevant relationships by Pil-sung Yang