Amiodarone used with anticoagulant therapy linked to more bleeding-related hospitalizations than flecainide or sotalol

A cohort study of more than 90,000 older adults diagnosed with atrial fibrillation (Afib) who were treated with anticoagulants found that treatment with amiodarone during apixaban or rivaroxaban use was associated with greater risk for bleeding-related hospitalizations compared to flecainide or sotalol. The findings are published in Annals of Internal Medicine.

Apixaban and rivaroxaban are the most prescribed anticoagulants to prevent ischemic strokes in patients with Afib. However, amiodarone, the most prescribed medication to maintain sinus rhythm in patients with Afib, inhibits apixaban and rivaroxaban elimination, possibly increasing anticoagulant-related risk for bleeding.

Researchers from Vanderbilt University School of Medicine conducted a retrospective cohort study of 91,590 Medicare beneficiaries aged 65 years and older with Afib who were treated with anticoagulants and anti-arrhythmic drugs. 54,977 participants were treated with amiodarone and 36,613 with flecainide or sotalol.

The authors found that patients treated with amiodarone experienced a 44% increased risk for bleeding-related hospitalizations compared to patients using flecainide or sotalol. However, they found that these patients had no increased risk for ischemic stroke or systemic embolism. The authors note that the risk was most pronounced in patients taking rivaroxaban or with known risk factors for hemorrhagic complications of anticoagulant treatment.