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<p>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&#xa0;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.</p>

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Drug-related hepatotoxicity risk in elderly patients with atrial fibrillation: insights from the nationwide Italian START registry

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  • 发表日期：

    2025年12月31日

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  • Gianluca Gazzaniga,
  • Danilo Menichelli,
  • Daniela Poli,
  • Gualtiero Palareti,
  • Emilia Antonucci,
  • Arianna Pani,
  • Pasquale Pignatelli,
  • Daniele Pastori,
  • Benilde Cosmi,
  • Daniela Poli,
  • Elena Lotti,
  • Martina Berteotti,
  • Rossella Marcucci,
  • Walter Ageno,
  • Giovanna Colombo,
  • Doris Barcellona,
  • Giovanni Barillari,
  • Alessandra Poz,
  • Salvatore Bradamante,
  • Eugenio Bucherini,
  • Monica Vastola,
  • Luca Bucherini,
  • Paola Casasco,
  • Antonio Ciampa,
  • Antonio Chistolini,
  • Alessandra Serrao,
  • Luciano Crippa,
  • Raimondo De Cristofaro,
  • Erica De Candia,
  • Valeria De Micheli,
  • Igor Diemberger,
  • Giuseppe Boriani,
  • Marcello Di Nisio,
  • Ettore Porreca,
  • Anna Falanga,
  • Teresa Lerede,
  • Elvira Grandone,
  • Donatella Colaizzo,
  • Antonio Insana,
  • Nicola Lucio Liberato,
  • Domenico Lione,
  • Rosa Maria Lombardi,
  • Giacomo Lucarelli,
  • Giuseppe Malcangi,
  • Catello Mangione,
  • Giuliana Martini,
  • Marco Marzolo,
  • Giovanni Nante,
  • Vincenzo Oriana,
  • Carmelo Paparo,
  • Paolo Pedico,
  • Simona Pedrini,
  • Vittorio Pengo,
  • Antonietta Piana,
  • Francesco Cibecchini,
  • Simona Pezzella,
  • Pasquale Pignatelli,
  • Daniele Pastori,
  • Vincenza Rossi,
  • Lucia Ruocco,
  • Paolo Chiarugi,
  • Serena Rupoli,
  • Domizio Serra,
  • Carmine Spataro,
  • Margherita Reduzzi,
  • Chiara ambaglio,
  • Sophie Testa,
  • Oriana Paoletti,
  • Andrea Toma,
  • Vincenzo Toschi,
  • Rita Carlotta Santoro,
  • Claudio Vasselli,
  • Maddalena Loredana Zighetti,
  • Marco Cattaneo,
  • Gianmarco Podda

摘要

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.