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. 2024 Oct 15:15:1432713.
doi: 10.3389/fphar.2024.1432713. eCollection 2024.

Drug-drug-interactions in patients with atrial fibrillation admitted to the emergency department

Thorsten Bischof  1 , Fiona Nagele  2 , Marius M Kalkofen  3 , Maximilian E O Blechschmidt  3 , Hans Domanovits  3 , Markus Zeitlinger  1 , Christian Schoergenhofer  1 , Filippo Cacioppo  3
Affiliations

Drug-drug-interactions in patients with atrial fibrillation admitted to the emergency department

Thorsten Bischof et al. Front Pharmacol. .

Abstract

Introduction: Polypharmacy is a growing concern in healthcare systems. While available data on potential drug-drug interactions (pDDI) from emergency department (ED) patients is derived from heterogenous populations, this study specifically focused on patients with atrial fibrillation (AF). We hypothesized that patients with AF have similar comorbidities, receive similar drugs, and have similar pDDIs. The overarching aim was to highlight frequent pDDIs, providing practical guidance for treating healthcare professionals and consequently reduce the risk of adverse drug reactions.

Methods: Two hundred patients ≥18 years with AF, who received rate- or rhythm-controlling medication at the ED of the University Hospital Vienna, and who were on long-term medication before admission, were eligible. Long-term medication alone, as well as in combination with medication administered at the ED were analyzed for pDDIs using the Lexicomp® Drug interactions database.

Results: Within the long-term medication of patients', we identified 664 pDDIs. Drugs administered at the ED increased pDDIs more than 3-fold to 2085. Approximately, every fifth patient received a contraindicated drug combination (on average 0.24 per patient), while 70% received drug combinations for which therapy modifications are recommended (on average 1.59 per patient). The most frequently involved drugs included amiodarone, propofol, bisoprolol, enoxaparin, and acetylsalicylic acid. Increased risk of bleeding, QTc prolongation, and myopathy were among the most relevant potential consequences of these interactions.

Discussion: In conclusion, an optimization of medication would be advisable in almost every AF patient. Treating healthcare professionals should be cautious of drugs that increase bleeding risk, prolong QTc, or bear a risk for myopathy.

Keywords: atrial fibrillation; bleeding; drug-drug-interactions; emergency department; qtc-prolongation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

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