Arrhythmias & electrophysiology
Potential interactions between medications for rate control and direct oral anticoagulants: Population-based cohort and case-crossover study
Authors' conclusion
Our study showed no evidence of higher bleeding or cardiovascular risk associated with co-prescribed DOACs and amiodarone, diltiazem, or verapamil. Elevated risks of cardiovascular and all-cause mortality were only observed during DOAC initiation when diltiazem/amiodarone were being taken.
Study context
- Population
- DOAC users in the Clinical Practice Research Datalink Aurum, 2011–2019
- Participants
- 397,459 DOAC users
- Exposure
- Direct oral anticoagulants (DOACs) + amiodarone/diltiazem/verapamil vs DOACs + beta-blocker
- Outcome
- Ischemic stroke, MI, VTE, intracranial bleeding, gastrointestinal bleeding, other bleeding, CV mortality and all-cause mortality
Methodological detailscohort design, case-crossover design
- Cohort design
- Case-crossover design
Main finding
As reported in the abstract
- No difference in risk of any outcome between DOACs + amiodarone/diltiazem/verapamil and DOACs + beta-blocker (cohort design)
- 9075 co-prescribed amiodarone, 9612 co-prescribed diltiazem, 2907 co-prescribed verapamil
Observational data: associations, not effects.
Further findings
All-cause mortality, case-crossover design
| Comparison | OR (99% CI) | |
|---|---|---|
| DOAC initiation while taking amiodarone | 2.09 (1.37–3.18) | |
| DOAC monotherapy | 1.30 (1.25–1.35) | |
| 0.20.5125Odds ratio (log scale) |
- Similar findings for CV mortality and all-cause mortality respectively with diltiazem
Original publication
Potential interactions between medications for rate control and direct oral anticoagulants: Population-based cohort and case-crossover study. Heart Rhythm. Published 21 June 2024. doi:10.
Summarised from the published abstract; every number is checked against it