Background: Proton pump inhibition (PPI) reduces gastrointestinal bleeding on direct oral anticoagulants. However, there is a discussion regarding possible PPI-dabigatran interaction that may reduce the efficacy of this therapy and there is no information regarding the effect of PPI on xabans on-treatment activity.
Aim:The aim was to determine the impact of PPI on therapeutic anti-IIa in dabigatran and anti-Xa activity in rivaroxaban and apixaban-treated patients with atrial fibrillation (AF).
Study design:The pilot prospective study enrolled 77 xabans-treated patients (42 rivaroxaban-treated and 35 apixaban-treated patients) and 31 dabigatran-treated patients with AF. PPI was administrated in 44 xabans-treated patients and in 19 dabigatran-treated patients.
Method:Trough and peak anti-Xa activity was assessed with factor Xa-calibrated anti-Xa chromogenic analysis and anti-IIa activity with the Hemoclot Thrombin Inhibitor Assay.
Results: There were no significant differences in trough anti-Xa activity comparing PPI-treated patients and patients without PPI (80.5 ± 66.5 ng/mL in PPI group vs. 71.6 ± 64.1 ng/mL in non-PPI group, p = 0.57) also no significant differences in peak anti-Xa activity between compared groups (175.2 ± 102.5 ng/mL in PPI group vs. 202.9 ± 84.1 ng/mL in non-PPI group, p = 0.21). However, there were significant differences in dabigatran trough level comparing patients treated with PPI and patients without PPI (58.86 ± 36.76 ng/mL vs. 110.72 ± 88.47 ng/mL, P < 0.05). Similarly, there were significant differences in dabigatran peak level between compared groups (88.0 ± 20.5 ng/mL vs. 174.4 ± 139.64 ng/mL, P < 0.05).
Conclusions:This study did not reveal significant changes in xabans on-treatment anti-Xa activity according the PPI status but demonstrated the interaction between PPI and dabigatran levels in patients with AF.