Among elderly patients with atrial fibrillation, the use of the LiverTox A drug amiodarone was significantly associated with an increased risk of elevated liver function tests (OR 1.61).
Observational (n=8,215)
Yes
Does the use of LiverTox A drugs increase the risk of elevated liver function tests in elderly patients with atrial fibrillation?
A significant proportion of elderly patients with atrial fibrillation are prescribed drugs with high hepatotoxic potential, with amiodarone and methimazole independently associated with elevated liver function tests.
Effect estimate: OR 1.61 (95% CI 1.29-2.00)
p-value: p=<0.001
Atrial fibrillation (AF) patients frequently require polypharmacy, increasing the risk of drug-drug interactions and hepatotoxicity. We analyzed the use of drugs potentially associated with liver injury in anticoagulated AF patients. We applied the LiverTox classification to AF patients from the START registry, categorizing them based on the use of LiverTox A drugs (high risk of liver toxicity). Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (95%CIs) for factors associated with the use of these drugs and their impact on liver function tests (LFTs). Median age was 81 years with 46% of women. 8,215 AF patients were taking 40,355 distinct molecules at enrolment, with a median of 5 drugs per patient (IQR 3-7). Overall, 3,416 (41.6%) received at least one LiverTox A drug. These patients were more often male, overweight, smokers, hypertensive, diabetic, with cardiovascular or cerebrovascular history, and on polypharmacy. The most commonly prescribed LiverTox A drugs were statins, amiodarone, and allopurinol, both in the overall population and within subgroups stratified by major cardiovascular conditions. In multivariable logistic regression, among LiverTox A drugs, amiodarone (OR 1.61, 95%CI 1.29-2.00) and methimazole (OR 1.83, 95%CI 1.04-3.03) were associated with elevated LFTs. Among frequently prescribed drugs, warfarin, furosemide, ramipril, lansoprazole, and canrenone were also associated with increased LFTs. Direct oral anticoagulants, compared to warfarin, showed a lower risk of increased LFTs after adjustment for confounders. In conclusion, many AF patients are treated with drugs at high risk of hepatotoxicity.
Gazzaniga et al. (Wed,) conducted a observational in Atrial fibrillation (n=8,215). Amiodarone (LiverTox A drug) vs. Non-use of amiodarone was evaluated on Elevated transaminases (AST > 40 U/L or ALT > 45 U/L) (OR 1.61, 95% CI 1.29-2.00, p=<0.001). Among elderly patients with atrial fibrillation, the use of the LiverTox A drug amiodarone was significantly associated with an increased risk of elevated liver function tests (OR 1.61).