Evidence map›Paper›PMID 36149579›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2023

Association between concurrent use of diltiazem and DOACs and risk of bleeding in atrial fibrillation patients.

Mohammed Shurrab, Cynthia A Jackevicius, Peter C Austin, Karen Tu, Feng Qiu, Joseph Caswell, Faith Michael, Jason G Andrade, Dennis T Ko

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In one paragraph

Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. [Drug-drug interactions in critically ill patients].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
    Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mohammed ShurrabCardiology Department, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada. shurrabm@hotmail.com.ORCID http://orcid.org/0000-0003-2591-5111
Cynthia A JackeviciusInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Peter C AustinInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Karen TuInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Feng QiuICES, Toronto, ON, Canada.
Joseph CaswellHealth Sciences North Research Institute, Sudbury, ON, Canada.
Faith MichaelCardiology Department, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada.
Jason G AndradeHeart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada.
Dennis T KoInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiltiazem is a commonly used medication in patients with atrial fibrillation (AF) with potential for a drug-drug interaction (DDI) with direct oral anticoagulants (DOACs). We aimed to assess the risk of major bleeding after co-prescription of diltiazem and DOACs among adults with AF.

methodsWe conducted a population-based, nested case-control study in Ontario, Canada. The study population included all patients with AF > 66 years on a DOAC between April 1, 2011, and March 31, 2018. Cases were patients admitted with major bleeding (index date). Each case was matched to two controls. We categorized exposure to diltiazem before the index date as: (a) current users (diltiazem use within 7 days); (b) recent users (diltiazem use within 8 to 90 days); and (c) unexposed (no diltiazem prescription or diltiazem prescription > 90 days before index date). Conditional logistic regression models were used to examine the association between bleeding and diltiazem co-prescription.

resultsAmong 86,679 AF patients on a DOAC, the median age of AF patients was 80 years (interquartile range 75-85); 48.3% were women. We identified 2,766 cases (3.2%) who were hospitalized with major bleeding. After multivariable adjustment, there was a significant association between major bleeding and current use of diltiazem (adjusted odds ratio (aOR) 1.37; 95% confidence interval (CI) 1.08-1.73, p < 0.009) but no significant association between major bleeding and recent use of diltiazem (aOR 1.19, 95% CI 0.99-1.42, p = 0.06) as compared with the unexposed group.

conclusionsCurrent use of diltiazem was associated with major bleeding among AF patients receiving a DOAC.

Indexed as

Atrial FibrillationStrokeAdministration, OralAged, 80 and overAnticoagulantsCase-Control StudiesDiltiazemFemaleHemorrhageHumansMaleRetrospective StudiesAnticoagulantsDiltiazemAtrial fibrillationBleedingDiltiazemDOACsInteractions

Identifiers

PMID36149579

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.