SynthesisEuropean heart journal. Cardiovascular pharmacotherapy2025
Risk of bleeding with the concurrent use of amiodarone and DOACs: a systematic review and meta-analysis.
Synthesis in European heart journal. Cardiovascular pharmacotherapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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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.
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Who cites it
3 citing papers in PubMed.
- Early Bleeding Risk After DOAC Initiation With Concomitant Amiodarone in Older Adults With Atrial Fibrillation.Journal of cardiovascular electrophysiology · 2026Article
- Polypharmacy and Drug-Drug Interaction Architecture in Hospitalized Cardiovascular Patients: Insights from Real-World Analysis.Biomedicines · 2026Article
- The present and future of antiarrhythmic drugs.JRSM cardiovascular diseaseArticle
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsAmiodarone is frequently prescribed alongside direct oral anticoagulants (DOACs) in atrial fibrillation. There are concerns regarding drug-drug interactions (DDIs) between amiodarone and DOACs. The literature is conflicting on the clinical implications of this DDI, hence we conducted a meta-analysis to compare bleeding risk among patients receiving DOACs, with and without concurrent amiodarone. METHODS AND
resultsA systematic search was conducted for studies published between 1 January 2009 and 26 June 2024 in MEDLINE via PubMed, Embase, and CENTRAL. Included studies compared major bleeding in patients on concurrent amiodarone and DOACs to those on DOACs without amiodarone. Event rates were used to calculate odds ratios (ORs), which were pooled with a random-effects model. Nine studies were identified, which included 124 813 patients on amiodarone/DOACs, and 314 074 on DOACs. The average age was 77.2 years in the amiodarone/DOAC group, compared to 74.4 years in the DOAC group (P = 0.21). Among DOAC patients, there was a statistically significant increase in major bleeding with concurrent amiodarone (OR 1.22, 95% confidence interval (CI) 1.03-1.44, P = 0.02, I2 = 88%). Intracranial bleeding rate was numerically higher in the amiodarone/DOAC group (1.0 vs. 0.4%), but the difference did not reach statistical significance (OR 2.20, 95% CI 0.53-9.06, P = 0.27, I2 = 100%). There were no significant differences in gastrointestinal bleeding (OR 1.10, 95% CI 0.98-1.23, P = 0.12, I2 = 62%) and all-cause mortality (OR 1.38, 95% CI 0.70-2.73, P = 0.35, I2 = 99%).
conclusionConcurrent use of amiodarone and DOACs was associated with an increase in major bleeding. This should be considered when co-prescribing these medications.
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