Among patients with atrial fibrillation (AF) who initiated apixaban or rivaroxaban, the use of diltiazem was associated with a higher risk for serious bleeding complications than the use of metoprolol. The risk for bleeding was particularly elevated in patients who received diltiazem doses exceeding 120 mg daily.

Patients with atrial fibrillation who use diltiazem combined with apixaban or rivaroxaban face an increased risk for serious bleeding events compared with those who use metoprolol.