Evaluating high serum digoxin concentration risk factors interaction between direct oral anticoagulant agents and digoxin

Year 2021, , 217 - 222, 30.06.2021

Hakan Çomaklı , Saadet Kader , Mustafa Agah Tekindal , Ata Niyazi Ecevit , Eren Günertem

https://doi.org/10.18663/tjcl.952903

Abstract

Aim:Digoxin is an anti-arrhythmic drug that also has a positive inotropic property. It is mainly used to control heart rate in nonvalvular atrial fibrillation, and improve ejection fraction in heart failure. In recent years, the frequency of digoxin and a combination of new drug using has been increasing. Therefore, to assess the pharmacokinetic interaction between direct oral anticoagulant agents and cardiovascular drugs is necessary for intoxications.
Material and Methods:Patients Serum Digoxin Concentrations levels and digoxin intoxications were evaluated according to risk factors investigated retrospectively Patients Serum Digoxin Concentrations levels <1 ng/ml is accepted as low, 1-2 ng/ml therapeutic range, 2.1-2.4 ng/ml is high and >2.4 ng/ml toxicity.
Results:The study consisted of 248 females (60.2%) and 160 males (39.2%). The mean age of the patients was 70.5 years. The average age of patients was 70.5 years. Serum digoxin concentrations of 408 patients; 44.81% were detected in the low therapeutic range, 34.41% in the therapeutic range, 6.23% in the high therapeutic range, 14.55% in the toxic therapeutic range. The mean glomerular filtration rate was 58.45, and the mean Serum Digoxin Concentration was 1.36 ng/ml. The statistically significant relationship between age and Patients Serum Digoxin Concentration was 16.3% (p <0.05). There was a statistically significant relationship between Glomerular Filtration Rate and Serum Digoxin Concentrations; one increased and the other decreased (p <0.05). In patients without atherosclerotic heart disease, Serum Digoxin Concentration was significantly lower than those with atherosclerotic heart disease(p< 0.05). Serum Digoxin Concentrations were significantly higher in patients treated with rivaroxaban, the proportions of which differ significantly from each other at the 0.05 level.
Conclusion:Nowadays, the frequency of using digoxin and direct oral anticoagulants together is increasing. The narrow therapeutic level of digoxin necessitates close monitoring due to drug-drug interactions.

Keywords

serum digoxin concentration, drug interaction, direct oral anticoagulant

Yüksek serum digoksin konsantrasyonu risk faktörlerinin değerlendirilmesi direkt oral antikoagülan ajanlar ve digoksin arasındaki etkileşim

Abstract

Amaç:Digoksin, pozitif inotropik özelliğe sahip anti-aritmik bir ilaçtır. Esas olarak valvüler olmayan atriyal fibrilasyonda kalp hızını kontrol etmek ve kalp yetmezliğinde ejeksiyon fraksiyonunu iyileştirmek için kullanılır. Son yıllarda digoksin ve yeni ilaç kombinasyonlarının kullanım sıklığı artmaktadır. Bu nedenle, doğrudan oral antikoagülan ajanlar ile kardiyovasküler ilaçlar arasındaki farmakokinetik etkileşimi değerlendirmek, zehirlenmeler için gereklidir.
Gereç ve Yöntemler:Hastalar Serum Digoksin Konsantrasyonları seviyeleri ve digoksin intoksikasyonları retrospektif risk faktörlerine göre değerlendirildi. Serum Digoxin Konsantrasyonu seviyeleri <1 ng / ml düşük, 1-2 ng / ml tedavi aralığı, 2.1-2.4 ng / ml yüksek ve> 2.4 ng / ml toksisite olarak kabul edilmektedir.
Bulgular:Çalışma 248 kadın (% 60,2) ve 160 erkek hastadan (% 39,2) oluşturuldu. Hastaların ortalama yaşı 70,5 idi. 408 hastanın serum digoksin konsantrasyonları; % 44.81’i düşük terapötik aralıkta, % 34.41’i terapötik aralıkta, % 6.23’ü yüksek terapötik aralıkta, % 14.55’i toksik terapötik aralıkta saptanmıştır. Ortalama glomerüler filtrasyon hızı 58.45 ve ortalama Serum Digoxin Konsantrasyonu 1.36 ng / ml idi. Yaş ile Serum Digoxin Konsantrasyonu arasındaki istatistiksel olarak anlamlı ilişki % 16,3 idi (p <0,05). Glomerüler Filtrasyon hızı ve Serum Digoxin konsantrasyonu arasında istatistiksel olarak anlamlı bir ilişki vardı; biri artarken diğeri azaldı (p <0,05). Aterosklerotik kalp hastalığı olmayan hastalarda Serum Digoxin konsantrasyonu, aterosklerotik kalp hastalığı olanlardan anlamlı olarak düşüktü (p <0.05). Serum Digoksin konsantrasyonları, rivaroksaban ile tedavi edilen hastalarda anlamlı olarak daha yüksekti ve bunların oranları 0.05 düzeyinde birbirinden önemli ölçüde farklıydı.
Sonuç: Günümüzde digoksin ve direkt oral antikoagülanların birlikte kullanım sıklığı artmaktadır. Digoksinin terapötik düzeyinin dar olması, ilaç-ilaç etkileşimleri nedeniyle yakın takibi gerektirir.

Keywords

serum digoksin konsantrasyonu, ilaç etkileşimi, direkt oral antikoagülan

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