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Abdul Mannan: When Antiseizure Drugs Alter DOAC Risk
Abdul Mannan/LinkedIn
Sep 9, 2026, 15:56

Abdul Mannan: When Antiseizure Drugs Alter DOAC Risk

Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn about a recent article by Kai Michael Schubert et al., published in JAMA Neurology, adding:

“DOAC plus epilepsy: The antiseizure medicine may alter more than seizure control.

The usual teaching is simple: avoid the obvious enzyme inducers.

This new study says the choice may be less tidy.

Schubert et al used a TriNetX target-trial emulation to compare adults taking a DOAC plus one antiseizure medicine with lamotrigine or lacosamide.

What stood out?

  • Strong inducers, including carbamazepine and phenytoin: more thromboembolism (HR 1.55), but less major bleeding (HR 0.62).That pattern fits reduced DOAC exposure.
  • Levetiracetam: more thromboembolism (HR 1.98) and death (HR 1.60), without less bleeding.This does not prove a drug interaction. It does mean ‘non-inducing’ is not the same as interaction-free.
  • Valproate: more intracranial major bleeding (HR 3.01) and death (HR 1.49).Confounding remains a real concern.

The VKA analysis was calmer: thromboembolic estimates were close to 1.

My take? For someone needing a DOAC, antiseizure drug choice deserves a joint neurology, cardiology and haematology review.

These are observational data, with no DOAC levels, so they are not a reason for abrupt ASM changes.”

Title: Safety of Antiseizure Medications During Direct Oral Anticoagulant Therapy in Epilepsy

Authors: Kai Michael Schubert, Carolina Ferreira-Atuesta, Arunachalam Soma, Johan Zelano, David J. Seiffge, Francesco Brigo, Eugen Trinka, Nishant K. Mishra, Emilio Russo, Gregory Y. H. Lip, Gashirai K Mbizvo, Marian Galovic

Abdul Mannan

Other posts featuring Abdul Mannan on Hemostasis Today.

 

Abdul Mannan Anticoagulation Arunachalam Soma bleeding Carolina Ferreira-Atuesta David J. Seiffge DOACs Emilio Russo Epilepsy Eugen Trinka Francesco Brigo Gashirai K Mbizvo Gregory Y.H. Lip Health Hematology Hemostasis Hemostasis News Hemostasis Today JAMA Neurology Johan Zelano Kai Michael Schubert Marian Galovic Medicine Nishant K. Mishra thrombosis TriNetX venous thromboembolism
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