Atrial, or atrial, fibrillation is the most common type of irregular heart rhythm and can lead to blood clots or stroke if left untreated. To prevent further complications from this disorder, patients are often prescribed blood thinning medications and treatments to control heart rhythm. “Genetic differences can impact how people metabolize medications. This is particularly important when multiple medications used for the same condition, such as atrial fibrillation, are affected by these differences in metabolism,” said Eli Zimmerman, professor at Northwestern University Feinberg School of Medicine (United States).
More risk of being hospitalized or dying from bleeding from diltiazem
In a study, the researcher and his team looked at these differences and how they can have negative effects. To carry out their work, published in the journal JAMA, reviewed the medical records of 204,155 adults, aged 65 or older, with atrial fibrillation. The participants, who were followed for 365 days, started using apixaban or rivaroxaban and also took diltiazem or metoprolol between January 1, 2012 and November 29, 2020. As a reminder, diltiazem, which is commonly prescribed to patients to reduce heart rate, “inhibits the elimination of apixaban and rivaroxaban, which may lead to overanticoagulation.”
According to the results, volunteers receiving diltiazem were 20% more likely to be hospitalized or die from bleeding. The risks were higher when the drug doses were larger, that is, greater than 120 mg per day. The authors noted there were no significant differences in the rates of stroke, systemic embolism or hemorrhage.
Atrial fibrillation: “metabolism differences can lead to increased risks of bleeding”
“These results are important because they show that while there are some benefits to using diltiazem over metoprolol, and vice versa, differences in metabolism may lead to increased risks of bleeding in people taking diltiazem (… “Next steps in our study may include consideration of the necessity or practicality of monitoring drug levels, which is the potential mechanism for increased bleeding risk,” said Eli Zimmerman.
