Safety and Effectiveness of Rivaroxaban in Combination with Various Antiarrhythmic Drugs in Patients with Non-Permanent Atrial Fibrillation

Introduction Rivaroxaban reduces the risk of thromboembolism in atrial fibrillation (AF) patients, who often also receive antiarrhythmic drugs (AADs) to maintain sinus rhythm. Current guidelines contraindicate concomitant use of rivaroxaban with the popular AAD dronedarone, despite little data demon...

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Published in:American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2021-07, Vol.21 (4), p.459-469
Main Authors: Chiou, Wei-Ru, Huang, Chun-Che, Lin, Po-Lin, Chuang, Jen-Yu, Liu, Lawrence Yu-Min, Su, Min-I, Liao, Feng-Ching, Chen, Chun-Yen, Kuo, Jen-Yuan, Tsai, Cheng-Ting, Wu, Yih-Jer, Lee, Ying-Hsiang
Format: Article
Language:English
Subjects:
Antiarrhythmics
Cardiac arrhythmia
Cardiology
Diabetes
Drug dosages
Electronic health records
Hypertension
Investigations
Medical records
Medicine
Medicine & Public Health
Original Research Article
Pharmacodynamics
Pharmacokinetics
Pharmacology/Toxicology
Pharmacotherapy
Stroke
Thromboembolism
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Summary:Introduction Rivaroxaban reduces the risk of thromboembolism in atrial fibrillation (AF) patients, who often also receive antiarrhythmic drugs (AADs) to maintain sinus rhythm. Current guidelines contraindicate concomitant use of rivaroxaban with the popular AAD dronedarone, despite little data demonstrating interactions with AADs. This study investigates the outcomes of concomitant rivaroxaban and AAD drug use in a real-world cohort. Methods This retrospective study included 1777 non-permanent AF patients taking rivaroxaban for ≥ 1 month between 2011 and 2016 from a multicenter cohort in Taiwan, and compared concomitant AAD use against clinical outcome endpoints for safety, effectiveness, and major adverse cardiac events (MACE). Multivariate Cox proportional hazard analyses were used to evaluate the association between concomitant AAD use and outcomes. Results Patients were divided into rivaroxaban alone ( n  = 1205) and with concomitant amiodarone ( n  = 177), dronedarone ( n  = 231), or propafenone ( n  = 164) groups. The proportion of patients using rivaroxaban 10 mg was highest in the concomitant dronedarone group: rivaroxaban alone, 53.6%; with amiodarone, 57.6%; with dronedarone, 77.1%; and with propafenone, 46.3% ( p  
ISSN:1175-3277
1179-187X
DOI:10.1007/s40256-020-00454-6