Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 528–531 | Cite as

Carbamazepine interaction with direct oral anticoagulants: help from the laboratory for the personalized management of oral anticoagulant therapy

  • Leonardo Di Gennaro
  • Stefano Lancellotti
  • Raimondo De Cristofaro
  • Erica De CandiaEmail author


Current guidelines recommend caution in prescribing concomitant use of direct-acting oral anticoagulants (DOACs) and antiepileptic drugs due to drug–drug interactions leading to potential risk of DOACs subtherapeutic concentration and treatment failure. Herein we report a significant interaction between carbamazepine (CZP) and apixaban, causing subtherapeutic concentration of the drug in a patient with atrial fibrillation who had a transient ischemic attack (TIA) episode. Another anti-Xa DOAC, edoxaban, administered to the patient after TIA occurrence did not show significant interaction with CZP. In addition to confirm that cautions should be used when antiepileptic and DOACs are concomitantly prescribed, the present case also demonstrates that, in the management of certain subsets of patients who need anticoagulant treatment, measurement of DOAC plasma concentration can help guide a personalized management and avoid adverse clinical outcomes.


Direct oral anticoagulant DOAC interaction Carbamazepin Anti-Xa activity Personalized oral anticoagulant therapy 



Non-valvular atrial fibrillation




International normalized ratio


Direct non-vitamin K antagonist oral anticoagulant


Vitamin-K antagonist


Transient ischemic attack


Compliance with ethical standards

Conflict of interest

The author(s) declared no conflicts of interest with respect to the authorship and/or publication of this article.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Leonardo Di Gennaro
    • 1
  • Stefano Lancellotti
    • 1
  • Raimondo De Cristofaro
    • 1
    • 2
  • Erica De Candia
    • 1
    • 2
    • 3
    Email author
  1. 1.Unità Operativa Malattie Emorragiche e Trombotiche, Area di EmatologiaFondazione Policlinico Universitario “Agostino Gemelli”, IRCCSRomeItaly
  2. 2.Istituto di Medicina Interna e GeriatriaUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Unità Operativa Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario “Agostino Gemelli”, IRCCSIstituto di Medicina Interna e Geriatria, Università Cattolica del Sacro CuoreRomeItaly

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