The Risk for Bleeding in Patients With Atrial Fibrillation From Concomitant Use of Apixaban or Rivaroxaban With Diltiazem Compared With Metoprolol - PubMed
5 hours ago
- #Atrial Fibrillation
- #Drug Interaction
- #Bleeding Risk
- The study compares bleeding risks in AF patients using apixaban or rivaroxaban with diltiazem versus metoprolol.
- Diltiazem, a CYP3A4 and P-glycoprotein inhibitor, may increase bleeding risk when combined with factor Xa inhibitors.
- A retrospective cohort study analyzed 46,000 AF patients (23,000 on diltiazem, 23,000 on metoprolol) using U.S. healthcare data.
- Diltiazem was associated with a higher bleeding risk than metoprolol (RD: 5.4 per 1000 person-years).
- High-dose diltiazem (>120 mg/d) showed a greater bleeding risk (RD: 9.2) than low-dose (RD: 2.6).
- 12- and 6-month risk differences between diltiazem and metoprolol were 0.48% and 0.31%, respectively.
- Study limitations include potential residual confounding.
- Conclusion: Diltiazem increases serious bleeding risk in AF patients on apixaban/rivaroxaban compared to metoprolol.