Clinical outcomes in patients with atrial fibrillation receiving amiodarone on NOACs vs. warfarin

Avendaño, Ricardo; Romero, Jorge; Lupercio, Florentino; Díaz, Juan Carlos; Quispe, Renato; Golive, Anjani; García, Mario J.; Krumerman, Andrew; Biase, Luigi Di

doi:10.1007/s10840-018-0427-y

Cited by 4 publications

(11 citation statements)

References 22 publications

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“…Among patients with atrial fibrillation (AF), considerable attention has been paid to long-term clinical outcomes, adherence to, and effectiveness of AF therapy [ 1 , 2 ]. The onset of AF is often associated with distressing symptoms such as heart palpitations, extreme fatigue, and shortness of breath [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

et al. 2020

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Background Holistic care models emphasize management of comorbid conditions to improve patient-reported outcomes in treatment of atrial fibrillation (AF). We investigated relations between multimorbidity, physical frailty, and self-rated health (SRH) among older adults with AF. Methods Patients (n = 1235) with AF aged 65 years and older were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. Ten previously diagnosed cardiometabolic and 8 non-cardiometabolic conditions were assessed from medical records. Physical Frailty was assessed with the Cardiovascular Health Study frailty scale. SRH was categorized as either “excellent/very good”, “good”, and “fair/poor”. Separate multivariable ordinal logistic models were used to examine the associations between multimorbidity and SRH, physical frailty and SRH, and multimorbidity and physical frailty. Results Overall, 16% of participants rated their health as fair/poor and 14% were frail. Hypertension (90%), dyslipidemia (80%), and heart failure (37%) were the most prevalent cardiometabolic conditions. Arthritis (51%), anemia (31%), and cancer (30%), the most common non-cardiometabolic diseases. After multivariable adjustment, patients with higher multimorbidity were more likely to report poorer health status (Odds Ratio (OR): 2.15 [95% CI: 1.53–3.03], ≥ 8 vs 1–4; OR: 1.37 [95% CI: 1.02–1.83], 5–7 vs 1–4), as did those with more prevalent cardiometabolic and non-cardiometabolic conditions. Patients who were pre-frail (OR: 1.73 [95% CI: 1.30–2.30]) or frail (OR: 6.81 [95% CI: 4.34–10.68]) reported poorer health status. Higher multimorbidity was associated with worse frailty status. Conclusions Multimorbidity and physical frailty were common and related to SRH. Our findings suggest that holistic management approaches may influence SRH among older patients with AF.

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Section: Introductionmentioning

confidence: 99%

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

et al. 2020

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“…A number of studies to date demonstrate an increase in serum concentration levels and/or prolonged clotting times, with the co-prescription of amiodarone, verapamil, or diltiazem with a DOAC 5,7,10,11,16,17,[21][22][23]30,33,35,50 . However, few examine clinically relevant hemorrhage events reflective of real-world practice.…”

Section: Discussionmentioning

confidence: 99%

“…Direct oral anticoagulants (DOACs) are a class of commonly prescribed anticoagulants used in the prevention of stroke in atrial fibrillation and in the treatment and prevention of venous thrombosis [1][2][3][4] . Many patients who require anticoagulation for atrial fibrillation or venous thrombosis are concurrently treated with medications to stabilize their heart rate and rhythm [5][6][7][8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

“…Verapamil, diltiazem and amiodarone are all moderate inhibitors of both CYP3A4 and P-gp activity, and the latter has been shown to increase the area under the concentration-time curve (AUC) for DOACs by 36% to >100% and their peak serum concentrations (Cmax) by 40% to 61% 5,7,10,11,30,31,33 . Verapamil and diltiazem are reported to increase AUC and Cmax for DOACS by 196% and 40%, and 250% and 31% respectively [21][22][23]34,35 .…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 Many patients who require anticoagulation for atrial fibrillation or venous thrombosis are concurrently treated with medications to stabilize their heart rate and rhythm. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Although DOACs have fewer drug–drug interactions than vitamin-K antagonists (VKAs), interactions still exist that can alter drug concentrations, efficacy, and safety and result in increased risks of thrombosis and bleeding. 8 , 14 , 15 , 16 , 17 , 18 Both events result in significant morbidity and mortality.…”

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Amiodarone, Verapamil, or Diltiazem Use With Direct Oral Anticoagulants and the Risk of Hemorrhage in Older Adults

et al. 2022

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Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Versus Warfarin in Patients with Atrial Fibrillation Using P-gp and/or CYP450-Interacting Drugs: a Systematic Review and Meta-analysis

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Vanspranghe

Steurbaut

et al. 2021

Cardiovasc Drugs Ther

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Purpose: Non-vitamin K antagonist oral anticoagulants (NOACs) are excreted by P-glycoprotein (P-gp) and some are metabolized by CYP450 enzymes such as CYP3A4. Although less drug interactions are present with NOACs, it is unclear whether NOACs should also be preferred over vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) using pharmacokinetically-interacting drugs. Therefore, the benefit-risk profile of NOACs versus VKAs was investigated in AF patients treated with P-gp and/or CYP450-interacting drugs.Methods: Using Pubmed and Embase, randomized controlled trials and observational studies on the effectiveness and safety of NOACs versus VKAs in AF patients using P-gp and/or CYP450-interacting drugs, were included. A meta-analysis was performed, calculating relative risks (RR) and 95% confidence intervals (CI) with the Mantel-Haenszel method.Results: Twelve studies were included, investigating 10,793 NOAC and 10,096 VKA users treated with Pgp/CYP3A4 inhibitors, whereas no studies on P-gp and/or CYP450-inducing drugs were identified. Compared to VKAs, NOACs were associated with a borderline non-significantly lower stroke or systemic embolism (stroke/SE) risk (RR 0.85, 95%CI (0.72-1.01)), significantly lower intracranial bleeding (RR 0.47, 95%CI (0.34-0.65)) and all-cause mortality risks (RR 0.87, 95%CI (0.79-0.95), but significantly higher gastrointestinal bleeding risk (RR 1.74, 95%CI (1.06-2.86)). Among AF patients using amiodarone, NOACs were associated with significantly lower stroke/SE (RR 0.71, 95%CI (0.54-0.93)) and intracranial bleeding risks (RR 0.51, 95%CI (0.29-0.88)), but significantly higher gastrointestinal bleeding risk (RR 2.15,)) than VKAs. Conclusion:The benefit-risk profile of NOACs compared to VKAs was preserved in AF patients using Pgp/CYP3A4 inhibitors, including amiodarone.

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Clinical outcomes in patients with atrial fibrillation receiving amiodarone on NOACs vs. warfarin

Abstract: Among patients with AF taking amiodarone, there is no increased risk of stroke, major bleeding, or ICB with NOACs compared to warfarin.

Cited by 4 publications

References 22 publications

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

Amiodarone, Verapamil, or Diltiazem Use With Direct Oral Anticoagulants and the Risk of Hemorrhage in Older Adults

Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Versus Warfarin in Patients with Atrial Fibrillation Using P-gp and/or CYP450-Interacting Drugs: a Systematic Review and Meta-analysis

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