Diltiazem Elevates Bleeding Risk in Atrial Fibrillation Patients on Anticoagulants, suggests study

A recent study highlights the potential risks associated with commonly prescribed medications for atrial fibrillation patients. The findings of this research were published in the Journal of American Medical Association which unveiled the concerning outcomes regarding the use of diltiazem in conjunction with anticoagulants such as apixaban or rivaroxaban.

This study was conducted on a substantial cohort of Medicare beneficiaries of 65 years and older to evaluate the serious bleeding risk among the patients with atrial fibrillation initiating anticoagulant therapy. This study analyzed data from over 200,000 patients who began treatment with either apixaban or rivaroxaban and concurrently started on diltiazem or metoprolol during the period of January 2012 and November 2020.

The retrospective cohort study spanned from August 2023 to February 2024 and revealed shocking trends. The patients who were receiving diltiazem underwent an increased risk of bleeding-related hospitalization and death when compared to the participants on metoprolol. Also, a composite of bleeding-related hospitalization and death with evidence of bleeding was the risk observed of the primary outcome, this was significantly higher in the diltiazem group. Further analysis pointed a dosage-dependent relationship where higher doses of diltiazem (>120 mg/d) correlated with greater risk. The patients who were on these higher doses expressed an increased risk of major ischemic or hemorrhagic events which emphasizing the dosage sensitivity of the observed outcomes.