Anti-seizure & Anticoagulant medications & interactions

CLOT Conversations

This is Episode 4 of CLOT Conversations from Thrombosis Canada. In this episode Dr Jameel Abdulrehman and David Airdrie are joined by Dr Vinai Bhagirath and Dr Sam Schulman, two of the authors of a recently published paper entitled Carbamazepine, phenytoin, and oral anticoagulants: Drug-drug interaction and clinical events in a retrospective cohort. The paper was published in Research and Practice in Thrombosis and Haemostasis (Res Pract Thromb Haemost. 2022;6:e12650. https://doi.org/10.1002/rth2.12650)
The authors discuss the results of the retrospective cohort of patients taking carbamazepine or phenytoin with warfarin or DOACs. In particular, they explore whether there is a relationship between anticoagulant levels and thromboembolic events. Dr Schulman and Dr Bhagirath discuss their perspectives on the issues relevant to each type of anticoagulant when used in patients on anti-seizure medications and what their study added to the understanding of drug-drug interactions.
Dr Sam Schulman graduated from Karolinska Institutet, Stockholm, Sweden in 1977 and has worked with coagulation disorders since 1984. Research activities have been clinical studies in venous thromboembolism, in hemophilia and bleeding.

He has been a member of the Executive Committee of the World Federation of Hemophilia, was President for the XXV ISTH Congress, Toronto, 2015, is member of the ISTH Council and Treasurer. In 2017 he received Harold R. Roberts medal of the ISTH SSC.

He is Director of the Thrombosis Service at Hamilton General Hospital and professor in Medicine at McMaster University, Hamilton, Canada, and at Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.

Dr Vinai Bhagirath, is a Thrombosis physician at Hamilton Health Sciences and Assistant Professor of Medicine at McMaster University. His research interests include bleeding risk with anticoagulants and clinical measurement of DOAC drug levels. His quality improvement interests include optimization of medical therapy in peripheral artery disease and standardization of periprocedural management of antithrombotic medications. His educational activities include Directorship of Thrombosis Fellowship programs at McMaster, and he is co-chair of the upcoming 2022 THSNA Summit and chair of Thrombosis Canada's Continuing Professional Development committee.

Thrombosis Canada Tools related to the content:

DOAC Drug Interaction tool: https://thrombosiscanada.ca/wp-uploads/uploads/2021/09/DDI-Tool-Final-English.pdf

Thrombosis Canada Clinical Guides: https://thrombosiscanada.ca/clinicalguides/

Follow us on Twitter:
Thrombosis Canada: @ThrombosisCan
Sam Schulman: @SamSchulman6

Reference:

Candeloro, M., Eikelboom, J. W., Chan, N., Bhagirath, V., Douketis, J. D., & Schulman, S. (2022). Carbamazepine, phenytoin, and oral anticoagulants: Drug‐drug interaction and clinical events in a retrospective cohort. Research and Practice in Thrombosis and Haemostasis, 6(2), e12650.

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