Effectiveness and safety of concomitant use of direct oral anticoagulants and antiarrhythmic drugs: a systematic review of observational studies
Bibliographic record
Abstract
INTRODUCTION: Concomitant use of antiarrhythmic drugs (AAs) may affect the effectiveness and safety of direct oral anticoagulants (DOACs) through pharmacokinetic interactions and other factors. Our systematic review aimed to provide an in-depth methodological assessment and synthesis of the available real-world evidence in the area. METHODS: We systematically searched MEDLINE/PubMed and EMBASE from January 2011 to October 2024 for observational studies assessing the effectiveness (risk of stroke) and safety (risk of major bleeding) associated with concomitant use of DOACs and AAs. We assessed the risk of bias using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. RESULTS: We identified 17 relevant studies including overall 2,613,693 patients. For stroke, all six studies showed no increased risk associated with concomitant use of DOACs and AAs. For major bleeding, seven studies showed an increased risk associated with concomitant use of DOACs and AAs (up to 187%), four studies showed heterogeneous results depending on the specific AA, and six studies showed no increased risk. When considering only higher-quality studies (n = 6), there was no association with the risk of stroke (n = 3). There were associations with an increased risk of major bleeding for concomitant use of DOACs and diltiazem (n = 2) or verapamil (n = 1), while findings for concomitant use of DOACs and amiodarone were inconsistent (n = 3). CONCLUSIONS: Based on the synthesis of higher-quality real-world evidence, concomitant use of AAs does not seem to impact the effectiveness of DOACs. Findings on safety possibly depend on the specific AA, with diltiazem showing the highest risk.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.116 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.012 |
| Bibliometrics | 0.012 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".