Wong Chun-Ka, Wong Yuen-Kwun, Chan Yap-Hang, Lin Minqing, Hai Jojo Siu-Han, Yiu Kai-Hang, Lip Gregory Yh, Lau Kui-Kai, Tse Hung-Fat
Department of Medicine, School of Clinical Medicine Li Ka Shing Faculty of Medicine, The University of Hong Kong Hong Kong SAR China.
Cardiac and Vascular Center The University of Hong Kong-Shenzhen Hospital Shenzhen China.
J Am Heart Assoc. 2025 May 6;14(9):e038668. doi: 10.1161/JAHA.124.038668. Epub 2025 Apr 17.
Non-vitamin K oral anticoagulants prevent stroke and systemic embolism in patients with nonvalvular atrial fibrillation. However, potential drug interactions with concomitant medications may compromise their efficacy and escalate the risk of adverse effects.
We conducted a territory-wide retrospective cohort study in Hong Kong, focusing on nonvalvular atrial fibrillation prescribed non-vitamin K oral anticoagulants. The objective was to investigate the associated risk of gastrointestinal bleeding, intracranial hemorrhage, hospitalization for major bleeding, and all-cause mortality in relation to various concomitant medications. Our analysis included 22 568 patients with nonvalvular atrial fibrillation (aged 75.7 ± 10.8 years; 51.2% men) taking non-vitamin K oral anticoagulants from January 1, 2017, to December 31, 2020, totaling 40 317 patient-years. It was found that amiodarone (hazard ratio [HR], 1.53), digoxin (HR, 1.30), diltiazem (HR, 1.18), clarithromycin (HR, 4.98), and fluconazole (HR, 2.38) were associated with increased gastrointestinal bleeding, whereas amiodarone (HR, 2.20) and digoxin (HR, 1.61) were associated with increased intracranial hemorrhage. Furthermore, amiodarone (HR, 1.64), digoxin (HR, 1.35), clarithromycin (HR, 4.18), and fluconazole (HR, 2.40) were associated with increased hospitalization for major bleeding. Additionally, amiodarone (HR, 2.65), digoxin (HR, 1.85), diltiazem (HR, 1.44), verapamil (HR, 1.80), antidepressants (HR, 1.31), and fluconazole (HR, 3.27) were associated with increased all-cause mortality. Conversely, dronedarone (HR, 0.56) and atorvastatin (HR, 0.86) were associated with a significant reduction in all-cause mortality.
For patients with nonvalvular atrial fibrillation taking non-vitamin K oral anticoagulants, several concurrent medications were associated with increased risks of intracranial hemorrhage, major bleeding hospitalizations, and overall mortality.
非维生素K口服抗凝药可预防非瓣膜性心房颤动患者的中风和全身性栓塞。然而，与同时服用的药物之间潜在的药物相互作用可能会损害其疗效，并增加不良反应的风险。
我们在香港进行了一项全地区范围的回顾性队列研究，重点关注开具非维生素K口服抗凝药的非瓣膜性心房颤动患者。目的是调查与各种同时服用的药物相关的胃肠道出血、颅内出血、因大出血住院以及全因死亡率的风险。我们的分析纳入了2017年1月1日至2020年12月31日期间服用非维生素K口服抗凝药的22568例非瓣膜性心房颤动患者（年龄75.7±10.8岁；男性占51.2%），总计40317患者年。结果发现，胺碘酮（风险比[HR]，1.53）、地高辛（HR，1.30）、地尔硫䓬（HR，1.18）、克拉霉素（HR，4.98）和氟康唑（HR，2.38）与胃肠道出血增加相关，而胺碘酮（HR，2.20）和地高辛（HR，1.61）与颅内出血增加相关。此外，胺碘酮（HR，1.64）、地高辛（HR，1.35）、克拉霉素（HR，4.18）和氟康唑（HR，2.40）与因大出血住院增加相关。另外，胺碘酮（HR，2.65）、地高辛（HR，1.85）、地尔硫䓬（HR，1.44）、维拉帕米（HR，1.80）、抗抑郁药（HR，1.31）和氟康唑（HR，3.27）与全因死亡率增加相关。相反，决奈达隆（HR，0.56）和阿托伐他汀（HR，0.86）与全因死亡率显著降低相关。
对于服用非维生素K口服抗凝药的非瓣膜性心房颤动患者，几种同时服用的药物与颅内出血、大出血住院和总体死亡率增加的风险相关。
