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Safety and Effectiveness of Rivaroxaban in Combination with Various Antiarrhythmic Drugs in Patients with Non-Permanent Atrial Fibrillation.
- Source :
- American Journal of Cardiovascular Drugs; Jul2021, Vol. 21 Issue 4, p459-469, 11p
- Publication Year :
- 2021
-
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. [ABSTRACT FROM AUTHOR]
- Subjects :
- THROMBOEMBOLISM risk factors
MYOCARDIAL depressants
DRUG efficacy
RESEARCH
COMBINATION drug therapy
MULTIVARIATE analysis
ATRIAL fibrillation
RETROSPECTIVE studies
MEDICAL cooperation
RIVAROXABAN
RISK assessment
COMPARATIVE studies
DRUG interactions
DRUG side effects
PATIENT safety
LONGITUDINAL method
PROPORTIONAL hazards models
Subjects
Details
- Language :
- English
- ISSN :
- 11753277
- Volume :
- 21
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- American Journal of Cardiovascular Drugs
- Publication Type :
- Academic Journal
- Accession number :
- 151291398
- Full Text :
- https://doi.org/10.1007/s40256-020-00454-6