30 May 2023

A new study has examined the risk of bleeding-related hospitalisation for patients with atrial fibrillation following the use of anti-arrhythmic drugs.

The most effective antiarrhythmic drug given for atrial fibrillation is amiodarone, which works by blocking specific electrical signals in the heart that may cause irregular heartbeat.

However, previous research has suggested it may also increase the risk of bleeding. This is because amiodarone inhibits the elimination of anti-coagulant drugs apixaban and rivaroxaban from the body.

The risk of bleeding-related hospitalisation among people taking amiodarone was compared to that from other antiarrhythmic drugs flecainide or sotalol in a US study.

Researchers from Vanderbilt University School of Medicine, Tennessee, USA, looked back on outcomes for 91,590 patients aged 65 years or older, treated between 2012 and 2018. All participants were also taking anti-coagulants apixaban or rivaroxaban.

The results showed that the risk for bleeding-related hospitalisations was around 44% higher on amiodarone, compared to flecainide or sotalol. The risk of death with evidence of recent bleeding was higher on amiodarone (66% increased risk), as well as risk of death from other causes (15% increase).

The risk was highest for those with known risk factors for haemorrhagic complications of anticoagulant treatment.

But the rates of ischaemic stroke or systemic embolism were similar between the different anti-arrhythmic drugs.

In the journal Annals of Internal Medicine, researcher Dr Wayne Ray and colleagues conclude: “In this retrospective cohort study, patients aged 65 years or older with atrial fibrillation treated with amiodarone during apixaban or rivaroxaban use had greater risk for bleeding-related hospitalizations than those treated with flecainide or sotalol.”


Ray WA, Chung CP, Stein CM, Smalley W, Zimmerman E, Dupont WD, Hung AM, Daugherty JR, Dickson AL, Murray KT. (2023) “Risk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation.” Annals of Internal Medicine, doi: 10.7326/M22-3238

Link: https://www.acpjournals.org/doi/10.7326/M22-3238

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