Warfarin–Antibiotic Interactions in Older Adults of an Outpatient Anticoagulation Clinic

Ghaswalla, Parinaz; Harpe, Spencer E.; Tassone, Daniel; Slattum, Patricia W.

doi:10.1016/j.amjopharm.2012.09.006

Cited by 32 publications

(30 citation statements)

References 21 publications

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“…One analysis in Norway showed that heparin, antibacterial and NSAIDs were common interacting drugs [26]. In parallel a retrospective cohort study, oral antibiotics ((azithromycin, levofloxacin, and Trimethoprim/sulphamethoxazole (TMP/SMX) were found to increase the incidence and degree of over anticoagulation [28]. Except rifampicin, most antibiotics are liver enzyme inhibitors and their interaction with warfarin may contribute to over anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

et al. 2014

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BackgroundWarfarin is known for its interaction with many drugs, resulting in undesired treatment outcomes such as bleeding. The study aimed to assess the prevalence of drug-drug interactions and determinants of bleeding among inpatients on warfarin therapy.MethodsA cohort of inpatients on warfarin treatment was prospectively followed from date of admission until discharge. The study was carried out from January to October 2013 in Ayder Referral Hospital, Northern Ethiopia. Patients on warfarin therapy during the study period and willing to participate were included as study subjects. Each concurrent medication was collected and checked for drug-drug interactions using Micromedex® online drug reference. Data were analyzed using statistical software, SPSS for windows version 16. The relationship between bleeding complications and independent variables (age, sex, residence, type and number of co-medications, dose and duration of warfarin treatment, INR value) was assessed using binary logistic regression analysis (Odds ratio, 95% confidence interval).ResultsOf the total 133 patients enrolled in the study, 78 (58.9%) were females. The mean age of the study participants was 40.81 ± 17.6 years. The prevalence of drug-drug interactions was 99.2%. Among these, 65 (49.2%) patients had at least one major while the others had moderate level of drug-drug interaction. Twenty two (16.5%) patients have developed bleeding complications. Increase in international normalized ratio value was found to be strongly associated with risk of bleeding (P value = 0.00; OR = 0.03 (0.00-0.46)).ConclusionDrug-drug interactions with warfarin were prevalent in the study hospital. Bleeding complications due to warfarin were also high. Thus, clinicians should be aware of potential interactions and monitor patients’ international normalized ratio closely.

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Section: Discussionmentioning

confidence: 99%

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

et al. 2014

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“…Although this increase did not result in significant outcomes of bleeding or hospitalization, this study highlights that INR should be routinely monitored in patients taking antibiotics. 6 In the present case series, all patients shared the similar history of major bleeding related to over anticoagulation. The temporal relationship between antibiotic prescription and the initiation of bleeding indicated that these medications are the potential agents associated within INR disruption.…”

Section: Casementioning

confidence: 88%

“…Some studies have also associated amoxicillin and cephalosporins with such interactions, particularly in elderly. [4][5][6] We presented four cases of warfarin-related bleeding, in which antibiotic co-prescription probably affected INR control and contributed to serious adverse events.…”

Section: Introductionmentioning

confidence: 99%

Major bleeding precipitated by interactions between antibiotics and warfarin: a case series

Marchesan¹,

Chemello²,

Thomé³

et al. 2018

IJCR

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“…Antibiotics (e.g., amoxicillin, azithromycin, ciprofloxacin, levofloxacin and moxifloxacin) may act through alteration of vitamin K synthesis in the gastrointestinal tract [74]. NSAIDs, including aspirin, and antiplatelet agents increase the risk of bleeding via multiple mechanisms, such as gastrointestinal toxicity, hepatic metabolism interaction and platelet function interference [75].…”

Section: Food and Drugs Interactionsmentioning

confidence: 99%

Minimizing the risk of hemorrhagic stroke during anticoagulant therapy for atrial fibrillation

Zoppellaro

Granziera

Jose

et al. 2015

Expert Opinion on Drug Safety

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Bleeding assessment is mandatory in order to select patients at high hemorrhagic risk who will benefit the most from close monitoring. Blood pressure, alcohol intake, concomitant medication and comorbidities should be constantly evaluated and treated accordingly. During VKA therapy, adherence and intensity of anticoagulation must be strictly monitored. DOAC are associated with lower risk of hemorrhagic stroke than VKA. However, periodic hepatic and renal checks as well as careful evaluation of time adherence are necessary to reduce the risk of bleeding.

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Warfarin–Antibiotic Interactions in Older Adults of an Outpatient Anticoagulation Clinic

Cited by 32 publications

References 21 publications

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study

Major bleeding precipitated by interactions between antibiotics and warfarin: a case series

Minimizing the risk of hemorrhagic stroke during anticoagulant therapy for atrial fibrillation

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