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Clinical outcomes in patients with atrial fibrillation receiving amiodarone on NOACs vs. warfarin

Authors
  • Avendano, Ricardo1
  • Romero, Jorge1
  • Lupercio, Florentino1
  • Diaz, Juan Carlos1
  • Quispe, Renato1
  • Golive, Anjani1
  • Natale, Andrea1, 2
  • Garcia, Mario J.1
  • Krumerman, Andrew K.1
  • Di Biase, Luigi1, 2
  • 1 Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA , Bronx (United States)
  • 2 Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA , Austin (United States)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Aug 20, 2018
Volume
54
Issue
1
Pages
73–80
Identifiers
DOI: 10.1007/s10840-018-0427-y
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeAmiodarone is a potent inhibitor of the CYP450:3A4 and inhibitor of the P-glycoprotein, both of which metabolize new oral anticoagulants (NOACs). Patients who are on NOACs and are concomitantly treated with amiodarone may have a higher risk of major bleeding according to recent retrospective trials. Whether this increased risk outweighs the benefits of NOACs compared to warfarin is unknown. We aimed to compare clinical outcomes between NOACs and warfarin in patients with atrial fibrillation (AF) being treated with amiodarone.MethodsWe performed a systematic review of MEDLINE, Cochrane, and Embase for randomized controlled trials that compared NOACs to warfarin for prophylaxis of ischemic stroke/thromboembolic events (TEs) in patients with AF and reported outcomes on TE, major bleeding, and intracranial bleeding (ICB). Risk ratio (RR) and 95% confidence intervals were measured using the Mantel-Haenszel method. Fixed effects model was used, and if heterogeneity (I2) was > 25%, effects were analyzed using a random model.ResultsA total of four studies comparing NOACs to warfarin were included in the analysis. The total number of patients on amiodarone was 6197. Mean follow up was 23 ± 5 months. No statistically significant difference for TE prevention (RR, 0.73; 95% CI 0.50–1.07), major bleeding (RR, 1.02; 95% CI 0.68–1.53), or ICB outcomes (RR, 0.58; 95% CI 0.22–1.51) between patients on NOACs + amiodarone when compared to patients on warfarin + amiodarone.ConclusionAmong patients with AF taking amiodarone, there is no increased risk of stroke, major bleeding, or ICB with NOACs compared to warfarin.

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