Can Janus kinase (JAK) inhibitors be taken concurrently with anticoagulants?

From the Guidelines

Taking JAK inhibitors while on anticoagulants requires careful medical supervision but is generally possible with appropriate monitoring. These medications can be used concurrently, but patients should be closely monitored for increased bleeding risk. Neither class of drugs is absolutely contraindicated with the other, though caution is warranted. If you're taking both types of medications, your doctor may recommend more frequent blood tests to monitor your clotting parameters, especially when starting or changing doses. The concern stems from the mechanism of action of JAK inhibitors, which can affect platelet function and potentially enhance the anticoagulant effect of blood thinners. Additionally, some JAK inhibitors may interact with certain anticoagulants through liver enzyme pathways, potentially affecting drug levels. Any signs of unusual bleeding, including easy bruising, nosebleeds, blood in urine or stool, or prolonged bleeding from cuts should be reported to your healthcare provider immediately. Your doctor may need to adjust dosages of either medication based on your specific medical conditions, other medications, and response to treatment.

Some key considerations when taking JAK inhibitors with anticoagulants include:

• Monitoring for increased bleeding risk
• Potential interactions between JAK inhibitors and anticoagulants through liver enzyme pathways
• Adjusting dosages of either medication based on individual patient factors
• Reporting any signs of unusual bleeding to your healthcare provider immediately

According to a study published in Circulation: Arrhythmia and Electrophysiology 1, concomitant use of anticoagulants and antiplatelet therapy can increase the risk of bleeding, but may be necessary in certain scenarios such as after valve implantation or in patients with acute coronary syndrome. The study recommends minimizing the duration of concomitant anticoagulant/antiplatelet therapy and using proton pump inhibitors to reduce the risk of gastrointestinal bleeding.

Another study published in the same journal 1 discusses the importance of considering drug-drug interactions when using oral anticoagulants, including interactions with antiplatelet agents. The study highlights the need for careful monitoring and individualized therapy to minimize the risk of adverse bleeding events.

Overall, while taking JAK inhibitors with anticoagulants requires careful monitoring and consideration of potential interactions, it can be done safely and effectively with appropriate medical supervision.

From the Research

Janus Kinase Inhibitors and Anticoagulants

• The use of Janus kinase (JAK) inhibitors with anticoagulants has been studied in various research papers 2, 3, 4, 5, 6.
• A study published in 2024 found that concurrent anticoagulation (AC) with JAK inhibitors appears to be protective against recurrent venous thromboembolic events (VTEs) in patients with a prior VTE history 2.
• The study observed that no new VTE events occurred during 65.2 patient-years of JAK inhibitor treatment with concurrent AC, demonstrating a lower risk of recurrent VTE (P = .020) 2.
• Another study published in 2018 estimated that thromboembolic risks are approximately five events per 1000 patient years with 4 mg baricitinib daily, and suggested that large observational studies are needed to accurately quantify thromboembolic risks attributable to JAK inhibitors 3.
• A self-controlled case series study published in 2022 found evidence of an increased risk of VTE and arterial thromboembolic events (ATE) associated with the use of baricitinib and tofacitinib, with an incident rate ratio (IRR) of 8.27 for VTE and 9.27 for ATE during JAK-i treatment 4.
• A retrospective review published in 2024 found that among 100 patients prescribed JAK inhibitors, there were no significant cases of VTE reported, with one patient developing a pulmonary embolism (PE) during treatment while also having COVID-19 5.
• A systematic review and meta-analysis published in 2021 found no statistically significant association between the use of JAK inhibitors and the risk of VTE, with an odds ratio of 0.91 and a 95% CI of 0.57 to 1.47 6.

Key Findings

• Concurrent anticoagulation with JAK inhibitors may be protective against recurrent VTEs in patients with a prior VTE history 2.
• JAK inhibitors may be associated with an increased risk of VTE and ATE, particularly in the short term 4.
• The risk of VTE and ATE associated with JAK inhibitors may vary depending on the specific medication and patient population 3, 4, 5.
• Further research is needed to fully understand the risks and benefits of using JAK inhibitors with anticoagulants 2, 3, 6.