Use of beta-blockers and risk of serious upper gastrointestinal bleeding: a population-based case-control study

Reilev, Mette; Damkier, Per; Rasmussen, Lotte; Olesen, Morten; Ernst, Martin; Rishøj, Rikke Mie; Hansen, Morten; Broe, Anne; Dastrup, Alexander; Hellfritzsch, Maja; Arnspang, Sidsel; Pottegård, Anton; Hallas, Jesper

doi:10.1177/1756283x17734116

Cited by 2 publications

(2 citation statements)

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“…Case-control studies found associations of calcium channel blockers with increased gastrointestinal bleeding; however, this finding was not confirmed by subsequent studies . Nonselective β-blockers are associated with reduced bleeding from gastroesophageal varices in patients with cirrhosis, but in more general populations, β-blockers are not associated with upper gastrointestinal bleeding …”

Section: Discussionmentioning

confidence: 99%

Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban

Ray,

Chung,

Stein

et al. 2024

JAMA

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ImportanceDiltiazem, a commonly prescribed ventricular rate–control medication for patients with atrial fibrillation, inhibits apixaban and rivaroxaban elimination, possibly causing overanticoagulation.ObjectiveTo compare serious bleeding risk for new users of apixaban or rivaroxaban with atrial fibrillation treated with diltiazem or metoprolol.Design, Setting, and ParticipantsThis retrospective cohort study included Medicare beneficiaries aged 65 years or older with atrial fibrillation who initiated apixaban or rivaroxaban use and also began treatment with diltiazem or metoprolol between January 1, 2012, and November 29, 2020. Patients were followed up to 365 days through November 30, 2020. Data were analyzed from August 2023 to February 2024.ExposuresDiltiazem and metoprolol.Main Outcomes and MeasuresThe primary outcome was a composite of bleeding-related hospitalization and death with recent evidence of bleeding. Secondary outcomes were ischemic stroke or systemic embolism, major ischemic or hemorrhagic events (ischemic stroke, systemic embolism, intracranial or fatal extracranial bleeding, or death with recent evidence of bleeding), and death without recent evidence of bleeding. Hazard ratios (HRs) and rate differences (RDs) were adjusted for covariate differences with overlap weighting.ResultsThe study included 204 155 US Medicare beneficiaries, of whom 53 275 received diltiazem and 150 880 received metoprolol. Study patients (mean [SD] age, 76.9 [7.0] years; 52.7% female) had 90 927 person-years (PY) of follow-up (median, 120 [IQR, 59-281] days). Patients receiving diltiazem treatment had increased risk for the primary outcome (RD, 10.6 [95% CI, 7.0-14.2] per 1000 PY; HR, 1.21 [95% CI, 1.13-1.29]) and its components of bleeding-related hospitalization (RD, 8.2 [95% CI, 5.1-11.4] per 1000 PY; HR, 1.22 [95% CI, 1.13-1.31]) and death with recent evidence of bleeding (RD, 2.4 [95% CI, 0.6-4.2] per 1000 PY; HR, 1.19 [95% CI, 1.05-1.34]) compared with patients receiving metoprolol. Risk for the primary outcome with initial diltiazem doses exceeding 120 mg/d (RD, 15.1 [95% CI, 10.2-20.1] per 1000 PY; HR, 1.29 [95% CI, 1.19-1.39]) was greater than that for lower doses (RD, 6.7 [95% CI, 2.0-11.4] per 1000 PY; HR, 1.13 [95% CI, 1.04-1.24]). For doses exceeding 120 mg/d, the risk of major ischemic or hemorrhagic events was increased (HR, 1.14 [95% CI, 1.02-1.27]). Neither dose group had significant changes in the risk for ischemic stroke or systemic embolism or death without recent evidence of bleeding. When patients receiving high- and low-dose diltiazem treatment were directly compared, the HR for the primary outcome was 1.14 (95% CI, 1.02-1.26).Conclusions and RelevanceIn Medicare patients with atrial fibrillation receiving apixaban or rivaroxaban, diltiazem was associated with greater risk of serious bleeding than metoprolol, particularly for diltiazem doses exceeding 120 mg/d.

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Section: Discussionmentioning

confidence: 99%

Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban

Ray,

Chung,

Stein

et al. 2024

JAMA

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“…GIB can affect the prognosis of AMI patients and increase the risk of major adverse cardiac events (MACEs) in the early stage (during hospitalization and within 30 days after discharge) and late stage (10)(11)(12). GIB is associated with markedly increased mortality and morbidity and can be life-threatening in patients with acute coronary syndromes (ACSs) (13). However, there is no systematic report on the risk factors and prognosis of GIB in AMI patients in China.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and risk factors of in-hospital gastrointestinal bleeding in patients with acute myocardial infarction

Zhong

Quan²,

Dang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundGastrointestinal bleeding (GIB) is one of the most serious complications of acute myocardial infarction (AMI) and is correlated with poor outcomes.ObjectiveTo evaluate the prevalence, risk factors and in-hospital mortality of GIB in patients with AMI.MethodsThis observational case-control study retrospectively enrolled consecutive patients with AMI from the Department of Cardiovascular Medicine and Cardiovascular Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2020. GIB after AMI was identified by International Classification of Diseases (ICD) codes from inpatient medical settings and validated by medical record review. AMI patients without GIB were accordingly classified as the control group. Propensity score matching (PSM) was used to match with the GIB group and the control group. All anonymized clinical data were provided by the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University.ResultsA total of 5,868 AMI patients were enrolled, 0.87% (51/5,868) of whom developed GIB after AMI. On the univariate analysis, history of diabetes, chronic kidney disease, Killip IV, a lower hemoglobin concentration, a higher serum level of creatinine, blood urea nitrogen and D-dimer were closely associated with the risk of GIB (P < 0.05). On the multivariable analysis, a lower hemoglobin concentration (OR: 0.93, 95% CI: 0.89–0.96, P < 0.001) was independently associated with the risk of GIB. Patients with GIB had a much higher in-hospital mortality rate than those without GIB (14.3 vs. 2.1%, P = 0.047). In-hospital mortality among patients with GIB after AMI appeared to be associated with a decreased hemoglobin concentration (OR: 0.93, 95% CI: 0.86–0.99, P = 0.045) and Killip IV (OR: 51.59, 95% CI: 2.65–1,005.30, P = 0.009).ConclusionThe history of diabetes, poor renal function and heart failure were associated with the high risk of GIB in patients experiencing AMI. The in-hospital mortality in patients with AMI complicating GIB was higher than that in patients without GIB and was associated with a decreased hemoglobin concentration and high Killip classification.

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Use of beta-blockers and risk of serious upper gastrointestinal bleeding: a population-based case-control study

Cited by 2 publications

References 34 publications

Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban

Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban

Clinical characteristics and risk factors of in-hospital gastrointestinal bleeding in patients with acute myocardial infarction

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