Use of non-vitamin K blood-thinners with certain medications associated with increased risk of major bleeding

October 03, 2017

Among patients with nonvalvular atrial fibrillation, concurrent use of certain commonly prescribed medications with non-vitamin K oral anticoagulants was associated with an increased risk of major bleeding, according to a study published by JAMA.

Oral anticoagulation has been proven to prevent ischemic strokes and prolong life for patients with atrial fibrillation. Non-vitamin K oral anticoagulants (NOACs) are being used more frequently because of their ease of administration and comparative efficacy compared with warfarin in reducing blood clots and major bleeding. However, for patients with atrial fibrillation, NOACs are often prescribed with other medications that share metabolic pathways that may increase major bleeding risk.

Chang-Fu Kuo, M.D., Ph.D., of Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues used data from the Taiwan National Health Insurance database and included 91,330 patients with nonvalvular atrial fibrillation who received at least one NOAC prescription of dabigatran, rivaroxaban, or apixaban and estimated the bleeding risk associated with or without the concurrent use of 12 commonly prescribed medications that share metabolic pathways with NOACs (atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin).

Among the patients in the study, 4,770 major bleeding events occurred. The researchers found that concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in incidence rates of major bleeding than NOACs alone. Compared with NOAC use alone, the incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone.

The study notes some limitations, including that bleeding risk and anticoagulant treatment in the Asian population have been recognized to be different from the Western population. Therefore, the external generalizability of these results, particularly to a Western population may be limited.

"Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs," the authors write.
-end-
For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jama.2017.13883)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To place an electronic embedded link to this study in your story This link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.13883

The JAMA Network Journals

Related Atrial Fibrillation Articles from Brightsurf:

Atrial fibrillation less deadly than it used to be, but still cause for concern: BU study
A first-of-its-kind study by researchers from the Boston University School of Public Health (BUSPH) shows a decline in deaths related to atrial fibrillation (irregular heartbeat) over the last 45 years.

Postoperative atrial fibrillation does not impact on overall survival after esophagectomy
Volume 11, Issue 25 of Oncotarget reported that Administration of landiolol hydrochloride was found to be associated with reduced incidence of atrial fibrillation after esophagectomy for esophageal cancer in our previous randomized controlled trial.

People with atrial fibrillation live longer with exercise
More than 100,000 Norwegians have atrial fibrillation. They should be actively exercising for their health.

Atrial fibrillation among overweight people is not due to fat
In a recently published study, researchers from Aarhus University document that the risk of atrial fibrillation is not linked to the amount of body fat, but instead to large muscle mass, or more precisely, a high fat-free weight

Eating more protein could help ward off atrial fibrillation in women
Women who ate slightly more than the recommended daily amount of protein were significantly less likely to develop atrial fibrillation (AFib), a dangerous heart rhythm disorder that can lead to stroke and heart failure, when compared with those who consumed less protein, according to research being presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Zebrafish teach researchers more about atrial fibrillation
Genetic research in zebrafish at the University of Copenhagen has surprised the researchers behind the study.

Personalized medicine for atrial fibrillation
The study, published in Europace, uses signals from implantable devices -- pacemakers and defibrillators -- to analyze electrical signals in the heart during episodes of atrial fibrillation.

Prescribing anticoagulants in the ED for atrial fibrillation increases long-term use by 30%
Patients prescribed anticoagulants after a diagnosis of atrial fibrillation in the emergency department are more likely to continue long-term use of medications to treat the condition, according to research published in CMAJ (Canadian Medical Association Journal).

Anticoagulant benefits for atrial fibrillation decrease with age
The net clinical benefit of anticoagulants for atrial fibrillation (AF) -- one of the most important causes of irregular heartbeats and a leading cause of stroke -- decreases with age, as the risk of death from other factors diminishes their benefit in older patients, according to a study led by researchers at UC San Francisco.

Research improves understanding of mechanism of atrial fibrillation
Mouse model studies show that noncoding DNA regions linked to atrial fibrillation risk can display long-range regulatory functions directed at Pitx2 gene and in this way predispose to the condition.

Read More: Atrial Fibrillation News and Atrial Fibrillation Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.