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Drug-drug interactions between vitamin K antagonists and statins: A systematic review
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  • Anna Engell,
  • Andreas Svendsen,
  • Bent Struer Lind,
  • Tore Stage,
  • Maja Hellfritzsch,
  • Anton Pottegard
Anna Engell
Hvidovre Hospital
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Andreas Svendsen
Odense University Hospital
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Bent Struer Lind
Hvidovre Hospital
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Tore Stage
University of Southern Denmark
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Maja Hellfritzsch
Syddansk Universitet Det Sundhedsvidenskabelige Fakultet
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Anton Pottegard
University of Southern Denmark
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Abstract

Abstract Concomitant use of Vitamin K antagonists (VKA) and statins is frequent in cardiovascular patients. However, clinical guidelines on this drug combination are divergent. Therefore, we performed a systematic review according to the PRISMA guidelines to evaluate the effect of statin initiation on coagulation among VKA users. Applying two broad search strategies for the drug interaction between VKA and statins in both Embase and Pubmed, 8,623 unique hits were obtained. In the final sample eight studies were included. The most frequent used VKA in the studies was warfarin while simvastatin was the most commonly initiated statin. All included studies showed a minor increase in the anticoagulant effect of VKA following statin initiation during VKA treatment. The reported increases in mean INR ranged from 0.15-0.65. The effect is likely to be of limited clinical relevance but should be evaluated individually.