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.

Also, the study did not identify significant differences in the risk of ischemic stroke, systemic embolism or death without recent evidence of bleeding between the two treatment groups. However, the increased risk of serious bleeding with diltiazem at higher doses underlines the need for cautious prescribing practices and close monitoring in this patient population.

Considering the widespread use of diltiazem and the increasing prevalence of atrial fibrillation among the elderly, the implications of these findings are substantial. Clinicians must weigh the benefits of diltiazem therapy against its potential risks when co-administered with anticoagulants. This study illuminates the importance of individualized treatment approaches and vigilant monitoring in managing atrial fibrillation when combining medications with potential interactions. With the base of these findings, further research would look into optimizing the therapeutic strategies in enhancing the patient safety and healthcare outcomes.

Reference:

Ray, W. A., Chung, C. P., Stein, C. M., Smalley, W., Zimmerman, E., Dupont, W. D., Hung, A. M., Daugherty, J. R., Dickson, A., & Murray, K. T. (2024). Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban. In JAMA (Vol. 331, Issue 18, p. 1565). American Medical Association (AMA). https://doi.org/10.1001/jama.2024.3867