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| Warfarin and GLP-1 Receptor Agonist Interaction Effects on Time in Therapeutic Range |
| Phillip Anjum1,2, Mikhail Y Akbashev1,2, Alyssa Utz2, Sydney Kisala2 1Emory University Department of Medicine, Atlanta, GA, United States/2Grady Memorial Hospital , Atlanta, GA, United States |
Introduction Warfarin is a commonly prescribed anticoagulant monitored using INR. Maximizing time in therapeutic range (TTR) is crucial for preventing stroke and major hemorrhage. GLP-1 receptor agonists manage diabetes and promote weight loss. While no known interactions exist between warfarin and GLP1-RA, secondary interactions due to gastrointestinal side effects cannot be ruled out. This study aimed to determine the impact of GLP-1 therapy initiation on INR control in patients receiving warfarin. Methods This retrospective cohort study reviewed patients concurrently prescribed warfarin and GLP1-RA from 1/1/2008 to 12/1/2023. Patients were excluded if they discontinued either medication within 90 days post-initiation or had fewer than four INR measurements within 90 days before and after GLP-1 agonist initiation. The primary outcome was TTR values pre- and post-GLP1-RA initiation. Secondary outcomes included the percentage of INR in range and time above and below range. Statistical analysis was performed using two-tailed t-tests comparing pre- and post-GLP-1 initiation periods. Results Of 81 patients screened, 28 patients met the above criteria to be included in the analysis. Thirteen patients (46%) were male. The average age of participants was 59.4 (minimum 38, maximum 80). Most (9, 32%) of the patients were on warfarin for mechanical valve, followed by afib/aflutter (7, 25%), venous thromboembolism (7, 25%), and other (5, 18%). At baseline, 22 (79%) of patients had a diagnosis of diabetes. Semaglutide was the most prescribed GLP1-RA (10, 36%), followed by exenatide (8, 28.5%), dulaglutide (5, 17.5%), liraglutide (4, 14%), and tirzepatide (1, 3.5%). Average TTR was 59% and 60% for the 90 days before and after GLP1-RA initiation, respectively (p=0.97). The percentage of in-range INRs were 56.6% and 51.9% for the pre-and post-initiation groups, respectively (p=0.51). No patients had bleeding post initiation of GLP1-RA. Among the sub-group of patients with baseline TTR greater or equal to 80%, post-GLP1-RA TTR decreased to 70%. Conclusion GLP1-RA therapy initiation in patients on warfarin did not significantly impact TTR. Some well-controlled patients experienced significant INR changes post-GLP1-RA initiation without bleeding events. |