The Drug-Induced Respiratory Disease Website

Anticoagulants, direct oral (anti-thrombin, -IIa, -Xa) - NOAC

Pneumonitis (ILD)

First cases observed in Japan

Capron T, Botto G, Roujon JJ, Miltgen J, Berard H

Drug-induced interstitial lung disease: Indictment for apixaban.

Respiratory medicine and research 2023 May 19;84;101024 — 2023 May 19 — 101024

Chan YH, Chao TF, Chen SW, Lee HF, Chen WM, Li PR, Yeh YH, Kuo CT, See LC, Lip GYH

Development of Interstitial Lung Disease Among Patients With Atrial Fibrillation Receiving Oral Anticoagulants in Taiwan.

JAMA network open 2022 Nov 01;5;e2243307 — 2022 Nov 01 — e2243307

Tomari S, Homma K, Noguchi T, Aiba T, Matsuki T, Suzuki R, Koga M, Takigami M, Tagawa H, Hashimoto T, Toyoda K

Development of Interstitial Lung Disease after Initiation of Apixaban Anticoagulation Therapy.

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2016 Jul;25;1767-1769 — 2016 Jul — 1767-1769

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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