Cardiology Department, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada; Health Sciences North Research Institute, Sudbury, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California; Pharmacy Department, VA Greater Los Angeles Healthcare System, California.
Am J Cardiol. 2023 Jan 1;186:58-65. doi: 10.1016/j.amjcard.2022.10.031. Epub 2022 Nov 4.
Amiodarone is a commonly used pharmacotherapy in patients with atrial fibrillation (AF), with a potential for drug-drug interactions with direct oral anticoagulants (DOACs). We aimed to assess the bleeding risk after co-prescription of amiodarone and DOACs among adults with AF. We conducted a population-based, nested case-control study in Ontario, Canada. The study population included all patients with AF aged >66 years on a DOAC between April 1, 2011 and March 31, 2018. Cases were patients admitted with major bleeding (index date). Controls were matched in a 2:1 ratio to cases. We categorized exposure to amiodarone before the index date as: (1) current users (amiodarone within 60 days), (2) past users (amiodarone within 61 to 140 days), and (3) unexposed (no amiodarone prescription or amiodarone prescription >140 days before index date). Conditional logistic regression models were used to examine the association between bleeding and amiodarone co-prescription. Among 86,679 patients with AF on a DOAC, we identified 2,766 cases (3.2%) admitted with major bleeding. The median age of patients with AF was 80 years (interquartile range 75 to 85); 48.3% were women. After multivariable adjustment, there was a significant association between major bleeding and current use of amiodarone (adjusted odds ratio 1.53; 95% confidence interval 1.24 to 1.89, p <0.001) but no significant association between major bleeding and past use of amiodarone (adjusted odds ratio 1.13, 95% confidence interval 0.76 to 1.68, p = 0.545) compared with the unexposed group. In conclusion, among older patients with AF on a DOAC, there was 53% increased odds of major bleeding with the current use of amiodarone.
胺碘酮是心房颤动（AF）患者常用的药物治疗方法，与直接口服抗凝剂（DOACs）有潜在的药物相互作用。我们旨在评估 AF 成年患者同时使用胺碘酮和 DOAC 后的出血风险。我们在加拿大安大略省进行了一项基于人群的嵌套病例对照研究。研究人群包括 2011 年 4 月 1 日至 2018 年 3 月 31 日期间使用 DOAC 的年龄>66 岁的所有 AF 患者。病例为因大出血（索引日期）入院的患者。对照组按 2:1 的比例与病例匹配。我们将索引日期前胺碘酮的暴露情况分为以下三类：（1）当前使用者（胺碘酮在 60 天内），（2）既往使用者（胺碘酮在 61 至 140 天内），（3）未暴露者（无胺碘酮处方或胺碘酮处方在索引日期前>140 天）。采用条件逻辑回归模型来检验出血与胺碘酮联合使用之间的关联。在 86679 名接受 DOAC 治疗的 AF 患者中，我们确定了 2766 例（3.2%）因大出血入院的病例。AF 患者的中位年龄为 80 岁（四分位间距 75 至 85）；48.3%为女性。多变量调整后，当前使用胺碘酮与大出血之间存在显著关联（调整后的优势比 1.53；95%置信区间 1.24 至 1.89，p<0.001），但与未暴露组相比，既往使用胺碘酮与大出血之间无显著关联（调整后的优势比 1.13；95%置信区间 0.76 至 1.68，p=0.545）。总之，在接受 DOAC 治疗的老年 AF 患者中，当前使用胺碘酮使大出血的风险增加了 53%。
