People with an irregular heartbeat who are taking diltiazem may be at increased risk of serious bleeding.
- Diltiazem is a heart rate control medication commonly prescribed for patients with atrial fibrillation.
- A new study shows that patients taking this treatment have a higher risk of serious bleeding than those taking metoprolol.
- The risks were higher when drug doses were higher than 120 mg per day.
Atrial fibrillation, or atrial fibrillation, is the most common type of irregular heartbeat and can lead to blood clots or stroke if left untreated. To prevent further complications from this condition, patients are often prescribed blood-thinning medications and treatments to control the heart rhythm. “Genetic differences can impact how people metabolize drugs. This is especially important when multiple drugs used for the same condition, such as atrial fibrillation, are affected by these differences in metabolism,” said Eli Zimmermanprofessor at Northwestern University Feinberg School of Medicine (United States).
Greater risk of being hospitalized or dying from bleeding due to 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 JAMAthey 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 as a result of bleeding. The risks were higher when the doses of the drugs were higher, meaning they were more than 120 mg per day. The authors noted that there were no significant differences in the rates of stroke, systemic embolism or bleeding.
Atrial fibrillation: “Metabolism differences may lead to increased bleeding risks”
“These findings are important because they show that while there are some advantages to using diltiazem over metoprolol, and vice versa, differences in metabolism may lead to increased bleeding risks in people taking diltiazem (…) Next steps in our study may include considering the need for or practicality of monitoring drug levels, which is the potential mechanism for increased bleeding risk,” Eli Zimmerman said.
