Division of Cardiology, Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.
College of Medicine Chang Gung University Taoyuan Taiwan.
J Am Heart Assoc. 2024 Nov 5;13(21):e033513. doi: 10.1161/JAHA.123.033513. Epub 2024 Nov 4.
This study investigated drug-drug interactions in patients with atrial fibrillation taking both a direct oral anticoagulant (DOAC) and an antiarrhythmic drug.
Using data from the National Health Insurance database (2012-2018), we identified 78 805 patients with atrial fibrillation on DOACs, with 24 142 taking amiodarone, 8631 taking propafenone, 2784 taking dronedarone, 297 taking flecainide, 177 taking sotalol, and 42 772 on DOACs alone. Patients with bradycardia, heart block, heart failure, mitral stenosis, prosthetic valves, or incomplete data were excluded. Propensity score matching compared those taking both DOACs and antiarrhythmic drugs with those on DOACs alone. There was an increased risk of major bleeding in patients concomitantly taking DOACs with amiodarone when compared with matched patients taking DOACs alone (hazard ratio [HR],1.13 [95% CI, 1.04-1.23]; =0.0044), particularly in patients taking dabigatran (HR, 1.19 [95% CI, 1.03-1.38]; =0.0175). No significant difference in bleeding risk was found for propafenone, dronedarone, flecainide, or sotalol. The small sample sizes in the flecainide and sotalol groups limit interpretation. Notably, intracranial bleeding risk was higher in patients on DOACs and amiodarone, regardless of age. Additionally, patients <80 years old taking dabigatran with amiodarone or propafenone had a higher risk of gastrointestinal bleeding.
Concomitant use of DOACs with amiodarone, but not dronedarone or propafenone, increases the risk of major bleeding, particularly intracranial bleeding. This study provides new evidence to guide clinicians to tailor concomitant anticoagulation and antiarrhythmic therapy for patients with atrial fibrillation.
本研究调查了同时服用直接口服抗凝剂（DOAC）和抗心律失常药物的房颤患者的药物相互作用。
利用国家健康保险数据库（2012-2018 年）的数据，我们确定了 78805 例服用 DOAC 的房颤患者，其中 24142 例服用胺碘酮，8631 例服用普罗帕酮，2784 例服用决奈达隆，297 例服用氟卡尼，177 例服用索他洛尔，42772 例单独服用 DOAC。排除心动过缓、心脏传导阻滞、心力衰竭、二尖瓣狭窄、人工瓣膜或数据不完整的患者。采用倾向评分匹配比较同时服用 DOAC 和抗心律失常药物的患者与单独服用 DOAC 的患者。与单独服用 DOAC 的匹配患者相比，同时服用 DOAC 和胺碘酮的患者大出血风险增加（风险比 [HR]，1.13 [95%CI，1.04-1.23]；=0.0044），尤其是服用达比加群的患者（HR，1.19 [95%CI，1.03-1.38]；=0.0175）。服用普罗帕酮、决奈达隆、氟卡尼或索他洛尔的患者出血风险无显著差异。氟卡尼和索他洛尔组的样本量较小，限制了结果的解释。值得注意的是，无论年龄大小，同时服用 DOAC 和胺碘酮的患者颅内出血风险更高。此外，年龄<80 岁的服用达比加群与胺碘酮或普罗帕酮的患者胃肠道出血风险更高。
同时服用 DOAC 和胺碘酮（而非决奈达隆或普罗帕酮）会增加大出血风险，尤其是颅内出血风险。本研究为指导临床医生为房颤患者量身定制抗凝和抗心律失常治疗提供了新的证据。
