Old and new oral anticoagulants: Food, herbal medicines and drug interactions

Alessandro Di Minno, Beatrice Frigerio, Gaia Spadarella, Alessio Ravani, Daniela Sansaro, Mauro Amato, Joseph P. Kitzmiller, Mauro Pepi, Elena Tremoli, Damiano Baldassarre

Research output: Contribution to journalReview articlepeer-review


The most commonly prescribed oral anticoagulants worldwide are the vitamin K antagonists (VKAs) such as warfarin. Factors affecting the pharmacokinetics of VKAs are important because deviations from their narrow therapeutic window can result in bleedings due to over-anticoagulation or thrombosis because of under-anticoagulation. In addition to pharmacodynamic interactions (e.g., augmented bleeding risk for concomitant use of NSAIDs), interactions with drugs, foods, herbs, and over-the-counter medications may affect the risk/benefit ratio of VKAs. Direct oral anticoagulants (DOACs) including Factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and thrombin inhibitor (dabigatran) are poised to replace warfarin. Phase-3 studies and real-world evaluations have established that the safety profile of DOACs is superior to those of VKAs. However, some pharmacokinetic and pharmacodynamic interactions are expected. Herein we present a critical review of VKAs and DOACs with focus on their potential for interactions with drugs, foods, herbs and over-the-counter medications.

Original languageEnglish
Pages (from-to)193-203
Number of pages11
JournalBlood Reviews
Issue number4
Publication statusPublished - Jul 1 2017


  • Co-morbidities
  • Direct anticoagulant drugs
  • Loss of efficacy
  • Patients characteristics
  • Therapeutic context
  • Thrombotic/bleeding events
  • Toxicity
  • Warfarin

ASJC Scopus subject areas

  • Hematology
  • Oncology


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