Evaluating the Concomitant Use of Diltiazem or Verapamil With Direct Oral Anticoagulants: A Meta-analysis.

IF 2.3 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Kazuhiko Kido, Mikiko Shimizu, Tsuyoshi Shiga, Masayuki Hashiguchi
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引用次数: 0

Abstract

Background: Diltiazem and verapamil are combined p-glycoprotein and moderate CYP3A4 inhibitors which significantly increase the concentrations of direct oral anticoagulants (DOACs) and may increase the risks of bleeding. Multiple real-world studies compared the concomitant therapy of diltiazem/verapamil and DOACs versus the DOAC monotherapy groups, but their main findings were contradictory.

Objective: To evaluate the risks of bleeding and stroke between the concomitant therapy of diltiazem/verapamil and DOACs and DOAC monotherapy.

Methods: A meta-analysis was performed to compare the concomitant therapy of diltiazem/verapamil and DOACs versus DOACs. Database searches through November 16, 2024 were performed using MEDLINE and Google Scholar. The primary outcome was major bleeding. The secondary outcomes included stroke or systemic embolism and gastrointestinal bleeding.

Results: A total of 6 studies were included in this meta-analysis. It showed that the concomitant therapy of DOAC and diltiazem/verapamil was significantly associated with increased risks of major bleeding (odds ratio [OR] = 1.38; 95% CI = 1.24, 1.54; P < 0.01; I2 = 0%) and gastrointestinal bleeding (OR = 1.19; 95% CI = 1.03, 1.37; P = 0.01; I2 = 0%) compared with the DOAC monotherapy group. The concomitant therapy group was also significantly associated with the lower risk of stroke or systemic embolism compared with the DOAC monotherapy group (OR = 0.83; 95% CI = 0.73, 0.93; I2 = 0%).

Conclusion and relevance: This meta-analysis found that the concomitant therapy of DOACs with diltiazem/verapamil increases the risks of bleeding outcomes compared with the DOAC monotherapy group.

评价地尔硫卓或维拉帕米与直接口服抗凝剂的合用:荟萃分析。
背景:地尔硫卓和维拉帕米是p-糖蛋白和中度CYP3A4抑制剂的联合应用,可显著增加直接口服抗凝剂(DOACs)的浓度,并可能增加出血的风险。多个现实世界的研究比较了地尔硫卓/维拉帕米和DOAC联合治疗与DOAC单药治疗组,但他们的主要发现是矛盾的。目的:评价地尔硫卓/维拉帕米与DOAC合用与DOAC单药治疗出血及卒中的危险性。方法:采用荟萃分析比较地尔硫卓/维拉帕米与DOACs与DOACs的联合治疗。使用MEDLINE和谷歌Scholar进行截至2024年11月16日的数据库搜索。主要结局是大出血。次要结局包括中风或全身性栓塞和胃肠道出血。结果:本meta分析共纳入6项研究。结果显示,DOAC与地尔硫卓/维拉帕米合用与大出血风险增加显著相关(优势比[OR] = 1.38;95% ci = 1.24, 1.54;P < 0.01;I2 = 0%)和胃肠道出血(OR = 1.19;95% ci = 1.03, 1.37;P = 0.01;I2 = 0%)与DOAC单药组比较。与DOAC单药治疗组相比,联合治疗组卒中或全身性栓塞的风险也显著降低(or = 0.83;95% ci = 0.73, 0.93;I2 = 0%)。结论及相关性:本荟萃分析发现,与DOAC单药治疗组相比,DOAC联合地尔硫卓/维拉帕米治疗增加了出血结局的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
0.00%
发文量
166
审稿时长
3-8 weeks
期刊介绍: Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days
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