Table 6.

Anticipated effects of common anti-cancer drugs on non-vitamin K antagonist oral anticoagulants plasma levels

Colour coding is based on the respective NOAC SmPC, drug interaction databases, or expert opinion. The hatched colour coding indicates no clinical or PK data available. Some of the colour codes will likely require adaptation as more data become available over time.

White: No relevant drug–drug interaction anticipated.

Yellow: Caution required, especially in case of polypharmacy or in the presence of ≥2 yellow/bleeding risk factors (see Figure 6).

Orange: Consider avoiding concomitant use, careful monitoring required if combined. See Figure 6.

Red: Contraindicated/not advisable due to increased plasma levels.

Orange: Dose reduction (edoxaban) recommended according to label.

Blue (dark): Contraindicated/not advisable due to reduced NOAC plasma levels.

Blue (light): Caution required, especially in case of polypharmacy or in the presence of ≥2 light blue interactions due to reduced NOAC plasma levels.

Where no data or SmPC instructions were available, expert opinion was generally based on the following principles:

 • Strong CYP3A4 and/or P-gp inducer—should not be used (dark blue).

 • Moderate CYP3A4 or P-gp inducer—use with caution or avoid (light blue).

 • Strong CYP3A4 and/or inhibitor—should not be used (red).

 • Moderate CYP3A4 and/or P-gp inhibitor—use with caution or avoid (orange).

 • Mild CYP3A4 and/or P-gp inducers or inhibitors—caution required especially with polypharmacy or in the presence of ≥2 bleeding risk factors (yellow).

Purine analogues: Mercaptopurine, Thioguanine, Pentostatin, Cladribine, Clofarabine, Fludarabine.

Pyrimidine analogues: Fluorouracil, Capecitabine, Cytarabine, Gemcitabine, Azacitadine, Decitabine.