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Study Says Increased Serious Bleeding Risk... Using Diltiazem With Apixaban or Rivaroxaban

Posted by mjamesone 
Like to hear opinions on this recent study.Of course Diltiazem with Apixaban or Rivaroxaban Is a common combination that many of us take (or have taken) including myself.



Edited 2 time(s). Last edit at 04/16/2024 02:20PM by mjamesone.
Looks like a ~21% increase in risk over the metoprolol for diltiazem doses > 120 mg and ~14% increase for lower doses.

Patients receiving diltiazem treatment had increased risk for the primary outcome (RD, 10.6 [95% CI, 7.0-14.2] per 1000 PY. In absolute terms, a 1.06% risk per person year. For metoprolol, the risk would be 21% less or 0.79 x 1.06% = 0.84% risk per person year. A difference, yes. However the absolute risk is low to begin with.
I was thinking similar although you are definitely better at the math smiling smiley Turns out not a new finding, with similar studies going back a few years and apparently not persuasive enough for at least the ep's I've worked with to mention the increased risk. On the other hand, I could see it an issue with some. I know one of the big selling point of NOAC's is that you don't have to monitor your blood as with Warafin, however I've always wondered about the one-size-fits-all dosing approach and this study further reinforces the point that someone could have more than required levels of Apixaban or Rivaroxaban, in this case if they are taking Diltiazem at the same time.

I have taken both metoprolol and diltiazem with apixaban over the years. My experience is that I bled more with metoprolol than taking diltiazem. I still bleed more than not taking it, but it did seem worse with metoprolol to me. I find this interesting, I will add it to my list of things to search for. Thanks!
I am so glad this information was posted. I have been on diltiazem and Eliquis for years! I have a telehealth visit with Dr. Natale in May and will certainly be asking him about this!!
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