Arrhythmias & electrophysiologyCohort study
The Risk for Bleeding in Patients With Atrial Fibrillation From Concomitant Use of Apixaban or Rivaroxaban With Diltiazem Compared With Metoprolol
- Retrospective cohort active comparator study
- propensity score matching
Authors' conclusion
In commercially insured patients with AF receiving apixaban or rivaroxaban, the use of diltiazem was associated with an increased risk for serious bleeding complications when compared with metoprolol.
Study context
- Population
- Persons with atrial fibrillation (AF) using apixaban or rivaroxaban with diltiazem or metoprolol, U.S. administrative health care databasematched cohort: 23,000 diltiazem users and 23,000 metoprolol users · diltiazem 23,000 · metoprolol 23,000
- Participants
- 23,000 vs 23,000
- Exposure
- diltiazem among patients with AF using apixaban or rivaroxaban
- diltiazemn = 23,000
- metoprololn = 23,000
- Outcome
- Composite of serious bleeding events leading to hospitalization
Main finding
As reported in the abstract
Rate difference, per 1000 person-years (95% CI)
diltiazem vs metoprololhigher risk with diltiazem
5.4(1.2–9.6)
Rate difference (CI)
high-dose diltiazem vs metoprololhigher risk with high-dose diltiazem; risk increased with high- versus low-dose
9.2(2.7–15.7)
low-dose diltiazem vs metoprololhigher risk with low-dose diltiazem
2.6(0.5–8.0)
Risk difference, percentage points (CI)
diltiazem vs metoprolol12-month; higher risk with diltiazem
0.48(0.09–0.83)
diltiazem vs metoprolol6-month; higher risk with diltiazem
0.31(0.04–0.58)
Observational data: associations, not effects.
Original publication
The Risk for Bleeding in Patients With Atrial Fibrillation From Concomitant Use of Apixaban or Rivaroxaban With Diltiazem Compared With Metoprolol. Ann Intern Med. Published 24 February 2026. doi:10.7326/annals-25-01408
Summarised from the published abstract; every number is checked against it