Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation
Background/purpose: Amiodarone increases exposure of direct oral anticoagulants (DOACs). We aimed to analyze the effects of concurrent amiodarone use on DOAC concentrations and clinical outcomes. Methods: Patients who were ≥20 years of age, had atrial fibrillation, and took DOAC were enrolled to pro...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664623000669 |
| _version_ | 1797780048921493504 |
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| author | Shin-Yi Lin Yen-Bin Liu Li-Ting Ho Yu-Fong Peng Ching-Hua Kuo Sung-Chun Tang Chih-Fen Huang Jiann-Shing Jeng |
| author_facet | Shin-Yi Lin Yen-Bin Liu Li-Ting Ho Yu-Fong Peng Ching-Hua Kuo Sung-Chun Tang Chih-Fen Huang Jiann-Shing Jeng |
| author_sort | Shin-Yi Lin |
| collection | DOAJ |
| description | Background/purpose: Amiodarone increases exposure of direct oral anticoagulants (DOACs). We aimed to analyze the effects of concurrent amiodarone use on DOAC concentrations and clinical outcomes. Methods: Patients who were ≥20 years of age, had atrial fibrillation, and took DOAC were enrolled to provide trough and peak samples for DOAC concentration measurements using ultra-high-performance liquid chromatography-tandem mass spectrometry. The results were compared with concentrations reported in clinical trials to define above, within, or under the expected range. The outcomes of interest were major bleeding and any gastrointestinal bleeding. Multivariate logistic regression and Cox proportional hazards model were used to determine the impact of amiodarone on above-range concentration and clinical outcomes, respectively. Results: A total of 722 participants (420 men, 58.2%) were enrolled to provide 691 trough samples and 689 peak samples. Among them, 21.3% concurrently used amiodarone. The proportion of patients with above-range trough and peak concentrations was 16.4% and 30.2%, respectively, for amiodarone users, in contrast to 9.4% and 19.8% for amiodarone non-users. The use of amiodarone was associated with above-range trough and peak concentrations (odds ratio [OR] = 2.00 [1.16, 3.47] and 1.82 [1.19, 2.79], respectively). However, amiodarone was not a significant predictor of major bleeding or any gastrointestinal bleeding. Conclusion: Concurrent amiodarone use led to increased DOAC concentration but was not associated with a higher risk of major bleeding or any gastrointestinal bleeding. Therapeutic monitoring of DOAC users concurrently taking amiodarone may be recommended for patients with an additional risk of increased DOAC exposure. |
| first_indexed | 2024-03-12T23:39:03Z |
| format | Article |
| id | doaj.art-b6dfd78cb968453e83962cb759af6eea |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-03-12T23:39:03Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-b6dfd78cb968453e83962cb759af6eea2023-07-15T04:28:14ZengElsevierJournal of the Formosan Medical Association0929-66462023-08-011228776784Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillationShin-Yi Lin0Yen-Bin Liu1Li-Ting Ho2Yu-Fong Peng3Ching-Hua Kuo4Sung-Chun Tang5Chih-Fen Huang6Jiann-Shing Jeng7Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanCardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanCardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSchool of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanSchool of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. Department of Neurology, National Taiwan University Hospital, No. 7, ZhongShan South Road, Taipei 100, Taiwan. Fax: +886 2 23418395.Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, TaiwanBackground/purpose: Amiodarone increases exposure of direct oral anticoagulants (DOACs). We aimed to analyze the effects of concurrent amiodarone use on DOAC concentrations and clinical outcomes. Methods: Patients who were ≥20 years of age, had atrial fibrillation, and took DOAC were enrolled to provide trough and peak samples for DOAC concentration measurements using ultra-high-performance liquid chromatography-tandem mass spectrometry. The results were compared with concentrations reported in clinical trials to define above, within, or under the expected range. The outcomes of interest were major bleeding and any gastrointestinal bleeding. Multivariate logistic regression and Cox proportional hazards model were used to determine the impact of amiodarone on above-range concentration and clinical outcomes, respectively. Results: A total of 722 participants (420 men, 58.2%) were enrolled to provide 691 trough samples and 689 peak samples. Among them, 21.3% concurrently used amiodarone. The proportion of patients with above-range trough and peak concentrations was 16.4% and 30.2%, respectively, for amiodarone users, in contrast to 9.4% and 19.8% for amiodarone non-users. The use of amiodarone was associated with above-range trough and peak concentrations (odds ratio [OR] = 2.00 [1.16, 3.47] and 1.82 [1.19, 2.79], respectively). However, amiodarone was not a significant predictor of major bleeding or any gastrointestinal bleeding. Conclusion: Concurrent amiodarone use led to increased DOAC concentration but was not associated with a higher risk of major bleeding or any gastrointestinal bleeding. Therapeutic monitoring of DOAC users concurrently taking amiodarone may be recommended for patients with an additional risk of increased DOAC exposure.http://www.sciencedirect.com/science/article/pii/S0929664623000669AmiodaroneAtrial fibrillationAsianDrug concentrationDrug–drug interactionDOAC |
| spellingShingle | Shin-Yi Lin Yen-Bin Liu Li-Ting Ho Yu-Fong Peng Ching-Hua Kuo Sung-Chun Tang Chih-Fen Huang Jiann-Shing Jeng Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation Journal of the Formosan Medical Association Amiodarone Atrial fibrillation Asian Drug concentration Drug–drug interaction DOAC |
| title | Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation |
| title_full | Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation |
| title_fullStr | Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation |
| title_full_unstemmed | Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation |
| title_short | Impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation |
| title_sort | impact of amiodarone on plasma concentration of direct oral anticoagulant in patients with atrial fibrillation |
| topic | Amiodarone Atrial fibrillation Asian Drug concentration Drug–drug interaction DOAC |
| url | http://www.sciencedirect.com/science/article/pii/S0929664623000669 |
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