{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:11:17Z","timestamp":1789726277787,"version":"4.0.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Non\u2013vitamin K oral anticoagulants prevent stroke and systemic embolism in patients with nonvalvular atrial fibrillation. However, potential drug interactions with concomitant medications may compromise their efficacy and escalate the risk of adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a territory\u2010wide retrospective cohort study in Hong Kong, focusing on nonvalvular atrial fibrillation prescribed non\u2013vitamin K oral anticoagulants. The objective was to investigate the associated risk of gastrointestinal bleeding, intracranial hemorrhage, hospitalization for major bleeding, and all\u2010cause mortality in relation to various concomitant medications. Our analysis included 22\u2009568 patients with nonvalvular atrial fibrillation (aged 75.7\u2009\u00b1\u200910.8\u2009years; 51.2% men) taking non\u2013vitamin K oral anticoagulants from January 1, 2017, to December 31, 2020, totaling 40\u2009317 patient\u2010years. It was found that amiodarone (hazard ratio [HR], 1.53), digoxin (HR, 1.30), diltiazem (HR, 1.18), clarithromycin (HR, 4.98), and fluconazole (HR, 2.38) were associated with increased gastrointestinal bleeding, whereas amiodarone (HR, 2.20) and digoxin (HR, 1.61) were associated with increased intracranial hemorrhage. Furthermore, amiodarone (HR, 1.64), digoxin (HR, 1.35), clarithromycin (HR, 4.18), and fluconazole (HR, 2.40) were associated with increased hospitalization for major bleeding. Additionally, amiodarone (HR, 2.65), digoxin (HR, 1.85), diltiazem (HR, 1.44), verapamil (HR, 1.80), antidepressants (HR, 1.31), and fluconazole (HR, 3.27) were associated with increased all\u2010cause mortality. Conversely, dronedarone (HR, 0.56) and atorvastatin (HR, 0.86) were associated with a significant reduction in all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">For patients with nonvalvular atrial fibrillation taking non\u2013vitamin K oral anticoagulants, several concurrent medications were associated with increased risks of intracranial hemorrhage, major bleeding hospitalizations, and overall mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.038668","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T08:14:06Z","timestamp":1744877646000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Concomitant Drug Interactions With Non\u2013Vitamin K Oral Anticoagulants Are Associated With Bleeding and Mortality Risk in Patients With Nonvalvular Atrial Fibrillation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-9440","authenticated-orcid":false,"given":"Chun\u2010Ka","family":"Wong","sequence":"first","affiliation":[{"name":"Li Ka Shing Faculty of Medicine, The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6946-344X","authenticated-orcid":false,"given":"Yuen\u2010Kwun","family":"Wong","sequence":"additional","affiliation":[{"name":"Li Ka Shing Faculty of Medicine, The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5384-8468","authenticated-orcid":false,"given":"Yap\u2010Hang","family":"Chan","sequence":"additional","affiliation":[{"name":"Li Ka Shing Faculty of Medicine, The University of Hong Kong","place":["Hong Kong, 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