Wei-Ru Chiou1,2, Chun-Che Huang3, Po-Lin Lin4,5, Jen-Yu Chuang6, Lawrence Yu-Min Liu2,4, Min-I Su1, Feng-Ching Liao7, Chun-Yen Chen7, Jen-Yuan Kuo2,7, Cheng-Ting Tsai7, Yih-Jer Wu2,7, Ying-Hsiang Lee8,9. 1. Division of Cardiology, Taitung MacKay Memorial Hospital, Taitung, Taiwan. 2. Department of Medicine, Mackay Medical College, New Taipei, Taiwan. 3. Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan. 4. Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan. 5. Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan. 6. Department of Medical Education, MacKay Memorial Hospital, Taipei, Taiwan. 7. Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan North Road Section 2, Zhongshan District, Taipei, Taiwan. 8. Department of Medicine, Mackay Medical College, New Taipei, Taiwan. speakerlee@gmail.com. 9. Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan North Road Section 2, Zhongshan District, Taipei, Taiwan. speakerlee@gmail.com.
Abstract
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 < 0.001). The cumulative incidences of safety (p = 0.892), effectiveness (p = 0.336), and MACE (p = 0.674) were similar between the four groups; however, there were significantly fewer new systemic thromboembolisms in the dronedarone group: rivaroxaban alone, 2.5%; with amiodarone, 0.6%; with dronedarone, 0%; and with propafenone, 1.2% (p = 0.029). The all-cause death rate was also lowest in the dronedarone group: rivaroxaban alone, 9.0%; with amiodarone, 9.6%; with dronedarone, 3.0%; and with propafenone: 6.1% (p = 0.013). After covariate adjustment, there were no differences in the safety, effectiveness, and MACE endpoints between patients receiving or not receiving AADs. CONCLUSION: Concomitant use of rivaroxaban with AADs appears to be well tolerated, warranting further investigation into the apparent benefits of a reduced dose of rivaroxaban combined with dronedarone.
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 < 0.001). The cumulative incidences of safety (p = 0.892), effectiveness (p = 0.336), and MACE (p = 0.674) were similar between the four groups; however, there were significantly fewer new systemic thromboembolisms in the dronedarone group: rivaroxaban alone, 2.5%; with amiodarone, 0.6%; with dronedarone, 0%; and with propafenone, 1.2% (p = 0.029). The all-cause death rate was also lowest in the dronedarone group: rivaroxaban alone, 9.0%; with amiodarone, 9.6%; with dronedarone, 3.0%; and with propafenone: 6.1% (p = 0.013). After covariate adjustment, there were no differences in the safety, effectiveness, and MACE endpoints between patients receiving or not receiving AADs. CONCLUSION: Concomitant use of rivaroxaban with AADs appears to be well tolerated, warranting further investigation into the apparent benefits of a reduced dose of rivaroxaban combined with dronedarone.
Authors: D G Wyse; A L Waldo; J P DiMarco; M J Domanski; Y Rosenberg; E B Schron; J C Kellen; H L Greene; M C Mickel; J E Dalquist; S D Corley Journal: N Engl J Med Date: 2002-12-05 Impact factor: 91.245
Authors: Pasquale Santangeli; Luigi Di Biase; Gemma Pelargonio; J David Burkhardt; Andrea Natale Journal: Ann Med Date: 2010-12-18 Impact factor: 4.709
Authors: Stefan H Hohnloser; Harry J G M Crijns; Martin van Eickels; Christophe Gaudin; Richard L Page; Christian Torp-Pedersen; Stuart J Connolly Journal: N Engl J Med Date: 2009-02-12 Impact factor: 91.245