Ann Intern Med

Common afib drug combo may increase risk of serious bleeding

March 6, 2026

A large U.S. cohort study of 46,000 matched patients with afib found that concomitant diltiazem use with apixaban or rivaroxaban was associated with a higher rate of serious bleeding hospitalizations compared with metoprolol (rate difference, 5.4 per 1,000 person‑years). Bleeding risk rose with higher diltiazem doses (>120 mg/day), reaching a rate difference of 9.2 per 1,000 person‑years. Six‑ and 12‑month absolute risk differences remained small but consistent.

Clinical takeaway: When managing afib patients on apixaban or rivaroxaban, consider metoprolol over diltiazem for rate control to reduce bleeding risk, especially at higher diltiazem doses, and closely monitor for bleeding if diltiazem use is necessary.

Source:

Dawwas GK, et al. (2026, February 24). Ann Intern Med. The Risk for Bleeding in Patients With Atrial Fibrillation From Concomitant Use of Apixaban or Rivaroxaban With Diltiazem Compared With Metoprolol. Ann Intern Med. https://pubmed.ncbi.nlm.nih.gov/41730211/