A new study has found that older patients with atrial fibrillation (AF) who are taking apixaban or rivaroxaban for anticoagulation treatment and also using amiodarone, an antiarrhythmic drug, are at a higher risk of bleeding-related hospitalizations than those using flecainide or sotalol. The study explains that amiodarone is the most effective antiarrhythmic drug but it inhibits apixaban and rivaroxaban elimination, which possibly increases the risk of anticoagulant-related bleeding.
The study was a retrospective analysis of US Medicare beneficiaries aged 65 years and above with AF who initiated anticoagulant use between 1 January 2012 and 30 November 2018 and were subsequently treated with antiarrhythmic drugs. The primary outcome was time to event for bleeding-related hospitalizations, while ischaemic stroke, systemic embolism, and death with or without recent evidence of bleeding were secondary. Adjustments were made with propensity score overlap weighting. The analysis included a total of 91,590 patients, with a mean age of 76.3 years, and 52.5 percent of whom were female. Of these, 54,977 received amiodarone, while 36,613 used flecainide or sotalol.
The results showed that amiodarone use was associated with an increased risk for bleeding-related hospitalizations. The rate difference was 17.5 events per 1,000 person-years and the hazard ratio was 1.44. However, there was no increase in the incidence of ischaemic stroke or systemic embolism. Mortality risk with recent evidence of bleeding was found to be higher compared with other deaths (RD, 9.1 events per 1,000 person-years). Additionally, the increased incidence of bleeding-related hospitalizations with rivaroxaban was higher than that with apixaban.
The study highlights the importance of considering the risk of bleeding when using amiodarone together with apixaban or rivaroxaban in older patients with AF. While amiodarone is an effective antiarrhythmic drug, its use may increase the anticoagulant-related risk of bleeding. Therefore, clinicians need to carefully evaluate the risks and benefits of this drug in combination with anticoagulant therapy. Patients taking amiodarone together with apixaban or rivaroxaban should be closely monitored for signs of bleeding, and appropriate interventions should be considered if necessary.
In conclusion, this study provides valuable insights into the risks associated with using amiodarone together with apixaban or rivaroxaban in older patients with AF. The results suggest that flecainide or sotalol may be a safer alternative to amiodarone in this patient population. However, further research is needed to confirm these findings and determine the optimal treatment strategy for this patient population. Clinicians should strive to balance the benefits of antiarrhythmic therapy with the potential risks of drug interactions in order to provide optimal care for patients with AF.
