Risk up with amiodarone versus flecainide or sotalol among seniors with atrial fibrillation receiving apixaban or rivaroxaban
By Elana Gotkine HealthDay Reporter
TUESDAY, May 23, 2023 (HealthDay News) — For patients with atrial fibrillation receiving apixaban or rivaroxaban, the risk of bleeding-related hospitalizations is greater during amiodarone treatment than flecainide or sotalol, according to a study published online May 22 in the Annals of Internal Medicine.
Wayne A. Ray, Ph.D., from the Vanderbilt University School of Medicine in Nashville, Tennessee, and colleagues compared risk for bleeding-related hospitalizations during treatment with amiodarone versus flecainide or sotalol in a retrospective cohort study. Data were included for 91,590 patients aged 65 years or older with atrial fibrillation who initiated use of anticoagulants and antiarrhythmic drugs: 54,977 with amiodarone and 36,613 with flecainide or sotalol.
The researchers observed an increase in the risk for bleeding-related hospitalizations with use of amiodarone (rate difference, 17.5 events per 1,000 person-years; hazard ratio, 1.44). No increase was seen in the incidence of ischemic stroke or systemic embolism. The risk of death with recent evidence of bleeding was higher than that seen for other deaths (risk difference, 9.1 versus 5.6 events per 1,000 person-years; hazard ratio, 1.66 versus 1.15). The increased incidence of bleeding-related hospitalizations was higher for rivaroxaban than for apixaban (risk difference, 28.0 versus 9.1 events per 1,000 person-years).
“These findings, consistent with pharmacokinetic data and case reports, suggest that bleeding risk should be considered in the management of rhythm control medications,” the authors write.
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