Michael Faith, Quevillon Travis, Maisonneuve Sabrina, Jackevicius Cynthia A, Crystal Eugene, Parkash Ratika, Andrade Jason G, Healey Jeff S, Ko Dennis T, Shurrab Mohammed
Department of Cardiology, Health Sciences North, 41 Ramsey Lake Road, Sudbury, Ontario P3E 5J1, Canada.
Department of General Internal Medicine, Queen's University, Kingston, Ontario K7L 3N6, Canada.
Eur Heart J Cardiovasc Pharmacother. 2025 May 2;11(3):241-250. doi: 10.1093/ehjcvp/pvae097.
Amiodarone is frequently prescribed alongside direct oral anticoagulants (DOACs) in atrial fibrillation. There are concerns regarding drug-drug interactions (DDIs) between amiodarone and DOACs. The literature is conflicting on the clinical implications of this DDI, hence we conducted a meta-analysis to compare bleeding risk among patients receiving DOACs, with and without concurrent amiodarone.
A systematic search was conducted for studies published between 1 January 2009 and 26 June 2024 in MEDLINE via PubMed, Embase, and CENTRAL. Included studies compared major bleeding in patients on concurrent amiodarone and DOACs to those on DOACs without amiodarone. Event rates were used to calculate odds ratios (ORs), which were pooled with a random-effects model. Nine studies were identified, which included 124 813 patients on amiodarone/DOACs, and 314 074 on DOACs. The average age was 77.2 years in the amiodarone/DOAC group, compared to 74.4 years in the DOAC group (P = 0.21). Among DOAC patients, there was a statistically significant increase in major bleeding with concurrent amiodarone (OR 1.22, 95% confidence interval (CI) 1.03-1.44, P = 0.02, I2 = 88%). Intracranial bleeding rate was numerically higher in the amiodarone/DOAC group (1.0 vs. 0.4%), but the difference did not reach statistical significance (OR 2.20, 95% CI 0.53-9.06, P = 0.27, I2 = 100%). There were no significant differences in gastrointestinal bleeding (OR 1.10, 95% CI 0.98-1.23, P = 0.12, I2 = 62%) and all-cause mortality (OR 1.38, 95% CI 0.70-2.73, P = 0.35, I2 = 99%).
Concurrent use of amiodarone and DOACs was associated with an increase in major bleeding. This should be considered when co-prescribing these medications.
在心房颤动患者中，胺碘酮常常与直接口服抗凝剂（DOACs）联合使用。人们担心胺碘酮与DOACs之间存在药物相互作用（DDIs）。关于这种药物相互作用的临床意义，文献报道存在矛盾之处，因此我们进行了一项荟萃分析，以比较同时使用和未同时使用胺碘酮的DOACs患者的出血风险。
通过PubMed、Embase和CENTRAL对MEDLINE数据库中2009年1月1日至2024年6月26日发表的研究进行了系统检索。纳入的研究比较了同时使用胺碘酮和DOACs的患者与未使用胺碘酮的DOACs患者的大出血情况。使用事件发生率计算比值比（ORs），并采用随机效应模型进行汇总。共确定了9项研究，其中124813例患者使用胺碘酮/DOACs，314074例患者使用DOACs。胺碘酮/DOAC组的平均年龄为77.2岁，而DOAC组为74.4岁（P = 0.21）。在DOACs患者中，同时使用胺碘酮会使大出血发生率有统计学显著增加（OR 1.22，95%置信区间（CI）1.03 - 1.44，P = 0.02，I² = 88%）。胺碘酮/DOAC组的颅内出血率在数值上更高（1.0%对0.4%），但差异未达到统计学显著性（OR 2.20，95% CI 0.53 - 9.06，P = 0.27，I² = 100%）。胃肠道出血（OR 1.10，95% CI 0.98 - 1.23，P = 0.12，I² = 62%）和全因死亡率（OR 1.38，95% CI 0.70 - 2.73，P = 0.35，I² = 99%）方面无显著差异。
胺碘酮与DOACs同时使用会增加大出血风险。在联合开具这些药物时应考虑到这一点。
