Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics
- Autores
- Yagi, Tatsuya; Mannheimer, Buster; Reutfors, Johan; Ursing, Johan; Giunta, Diego Hernan; Kieler, Helle; Linder, Marie
- Año de publicación
- 2023
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- Fluoroquinolones and macrolides may, due to a potential drug-drug interaction, increase the concentration of any concomitantly administered direct oral anticoagulant (DOAC) and thereby increase the risk of severe bleeding. However, clinical evidence for such an effect is scarce. The present study aimed to evaluate the association between the use of fluoroquinolones or macrolides and bleeding events in patients with concomitant DOAC use. This was a nationwide cohort study including 19 288 users of DOACs in 2008-2018 using information from Swedish national health registers. We compared the incidence of bleeding events associated with use of fluoroquinolones or macrolides using doxycycline as a negative control. Cox regression was used to calculate crude and adjusted hazard ratios (aHRs) in time windows of various length of follow-up after the start of antibiotic use. The incidence rates for fluoroquinolones and macrolides ranged from 12 to 24 and from 12 to 53 bleeding events per 100 000 patients in the investigated time windows. The aHRs (95% confidence interval) for use of fluoroquinolones and macrolides were 1.29 (0.69-2.44) and 2.60 (0.74-9.08) at the concomitant window, 1.31 (0.84-2.03) and 1.79 (0.75-4.29) at 30 days, and 1.34 (0.99-1.82) and 1.28 (0.62-2.65) at 150 days, respectively. With regard to fluoroquinolones, the present study suggests that the risk of bleeding when combined with DOACs, if any, is small. Codispensation of macrolides in patients on DOACs was not associated with an increased risk of bleeding. However, due to the small number of macrolide users, the results must be interpreted with caution.
Fil: Yagi, Tatsuya. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Mannheimer, Buster. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Reutfors, Johan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Ursing, Johan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Giunta, Diego Hernan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Kieler, Helle. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia
Fil: Linder, Marie. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia - Materia
-
BLEEDING
COHORT STUDY
DIRECT ANTICOAGULANTS
FLUOROQUINOLONES
MACROLIDES - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
- Repositorio
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/220055
Ver los metadatos del registro completo
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Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibioticsYagi, TatsuyaMannheimer, BusterReutfors, JohanUrsing, JohanGiunta, Diego HernanKieler, HelleLinder, MarieBLEEDINGCOHORT STUDYDIRECT ANTICOAGULANTSFLUOROQUINOLONESMACROLIDEShttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Fluoroquinolones and macrolides may, due to a potential drug-drug interaction, increase the concentration of any concomitantly administered direct oral anticoagulant (DOAC) and thereby increase the risk of severe bleeding. However, clinical evidence for such an effect is scarce. The present study aimed to evaluate the association between the use of fluoroquinolones or macrolides and bleeding events in patients with concomitant DOAC use. This was a nationwide cohort study including 19 288 users of DOACs in 2008-2018 using information from Swedish national health registers. We compared the incidence of bleeding events associated with use of fluoroquinolones or macrolides using doxycycline as a negative control. Cox regression was used to calculate crude and adjusted hazard ratios (aHRs) in time windows of various length of follow-up after the start of antibiotic use. The incidence rates for fluoroquinolones and macrolides ranged from 12 to 24 and from 12 to 53 bleeding events per 100 000 patients in the investigated time windows. The aHRs (95% confidence interval) for use of fluoroquinolones and macrolides were 1.29 (0.69-2.44) and 2.60 (0.74-9.08) at the concomitant window, 1.31 (0.84-2.03) and 1.79 (0.75-4.29) at 30 days, and 1.34 (0.99-1.82) and 1.28 (0.62-2.65) at 150 days, respectively. With regard to fluoroquinolones, the present study suggests that the risk of bleeding when combined with DOACs, if any, is small. Codispensation of macrolides in patients on DOACs was not associated with an increased risk of bleeding. However, due to the small number of macrolide users, the results must be interpreted with caution.Fil: Yagi, Tatsuya. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Mannheimer, Buster. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Reutfors, Johan. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Ursing, Johan. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Giunta, Diego Hernan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kieler, Helle. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Linder, Marie. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaWiley Blackwell Publishing, Inc2023-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/220055Yagi, Tatsuya; Mannheimer, Buster; Reutfors, Johan; Ursing, Johan; Giunta, Diego Hernan; et al.; Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics; Wiley Blackwell Publishing, Inc; British Journal Of Clinical Pharmacology; 89; 2; 2-2023; 887-8970306-5251CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1111/bcp.15531info:eu-repo/semantics/altIdentifier/url/https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.15531info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-nd/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T10:08:42Zoai:ri.conicet.gov.ar:11336/220055instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 10:08:43.122CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
dc.title.none.fl_str_mv |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
title |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
spellingShingle |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics Yagi, Tatsuya BLEEDING COHORT STUDY DIRECT ANTICOAGULANTS FLUOROQUINOLONES MACROLIDES |
title_short |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
title_full |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
title_fullStr |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
title_full_unstemmed |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
title_sort |
Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics |
dc.creator.none.fl_str_mv |
Yagi, Tatsuya Mannheimer, Buster Reutfors, Johan Ursing, Johan Giunta, Diego Hernan Kieler, Helle Linder, Marie |
author |
Yagi, Tatsuya |
author_facet |
Yagi, Tatsuya Mannheimer, Buster Reutfors, Johan Ursing, Johan Giunta, Diego Hernan Kieler, Helle Linder, Marie |
author_role |
author |
author2 |
Mannheimer, Buster Reutfors, Johan Ursing, Johan Giunta, Diego Hernan Kieler, Helle Linder, Marie |
author2_role |
author author author author author author |
dc.subject.none.fl_str_mv |
BLEEDING COHORT STUDY DIRECT ANTICOAGULANTS FLUOROQUINOLONES MACROLIDES |
topic |
BLEEDING COHORT STUDY DIRECT ANTICOAGULANTS FLUOROQUINOLONES MACROLIDES |
purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.2 https://purl.org/becyt/ford/3 |
dc.description.none.fl_txt_mv |
Fluoroquinolones and macrolides may, due to a potential drug-drug interaction, increase the concentration of any concomitantly administered direct oral anticoagulant (DOAC) and thereby increase the risk of severe bleeding. However, clinical evidence for such an effect is scarce. The present study aimed to evaluate the association between the use of fluoroquinolones or macrolides and bleeding events in patients with concomitant DOAC use. This was a nationwide cohort study including 19 288 users of DOACs in 2008-2018 using information from Swedish national health registers. We compared the incidence of bleeding events associated with use of fluoroquinolones or macrolides using doxycycline as a negative control. Cox regression was used to calculate crude and adjusted hazard ratios (aHRs) in time windows of various length of follow-up after the start of antibiotic use. The incidence rates for fluoroquinolones and macrolides ranged from 12 to 24 and from 12 to 53 bleeding events per 100 000 patients in the investigated time windows. The aHRs (95% confidence interval) for use of fluoroquinolones and macrolides were 1.29 (0.69-2.44) and 2.60 (0.74-9.08) at the concomitant window, 1.31 (0.84-2.03) and 1.79 (0.75-4.29) at 30 days, and 1.34 (0.99-1.82) and 1.28 (0.62-2.65) at 150 days, respectively. With regard to fluoroquinolones, the present study suggests that the risk of bleeding when combined with DOACs, if any, is small. Codispensation of macrolides in patients on DOACs was not associated with an increased risk of bleeding. However, due to the small number of macrolide users, the results must be interpreted with caution. Fil: Yagi, Tatsuya. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia Fil: Mannheimer, Buster. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia Fil: Reutfors, Johan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia Fil: Ursing, Johan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia Fil: Giunta, Diego Hernan. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Kieler, Helle. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia Fil: Linder, Marie. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia |
description |
Fluoroquinolones and macrolides may, due to a potential drug-drug interaction, increase the concentration of any concomitantly administered direct oral anticoagulant (DOAC) and thereby increase the risk of severe bleeding. However, clinical evidence for such an effect is scarce. The present study aimed to evaluate the association between the use of fluoroquinolones or macrolides and bleeding events in patients with concomitant DOAC use. This was a nationwide cohort study including 19 288 users of DOACs in 2008-2018 using information from Swedish national health registers. We compared the incidence of bleeding events associated with use of fluoroquinolones or macrolides using doxycycline as a negative control. Cox regression was used to calculate crude and adjusted hazard ratios (aHRs) in time windows of various length of follow-up after the start of antibiotic use. The incidence rates for fluoroquinolones and macrolides ranged from 12 to 24 and from 12 to 53 bleeding events per 100 000 patients in the investigated time windows. The aHRs (95% confidence interval) for use of fluoroquinolones and macrolides were 1.29 (0.69-2.44) and 2.60 (0.74-9.08) at the concomitant window, 1.31 (0.84-2.03) and 1.79 (0.75-4.29) at 30 days, and 1.34 (0.99-1.82) and 1.28 (0.62-2.65) at 150 days, respectively. With regard to fluoroquinolones, the present study suggests that the risk of bleeding when combined with DOACs, if any, is small. Codispensation of macrolides in patients on DOACs was not associated with an increased risk of bleeding. However, due to the small number of macrolide users, the results must be interpreted with caution. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-02 |
dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://purl.org/coar/resource_type/c_6501 info:ar-repo/semantics/articulo |
format |
article |
status_str |
publishedVersion |
dc.identifier.none.fl_str_mv |
http://hdl.handle.net/11336/220055 Yagi, Tatsuya; Mannheimer, Buster; Reutfors, Johan; Ursing, Johan; Giunta, Diego Hernan; et al.; Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics; Wiley Blackwell Publishing, Inc; British Journal Of Clinical Pharmacology; 89; 2; 2-2023; 887-897 0306-5251 CONICET Digital CONICET |
url |
http://hdl.handle.net/11336/220055 |
identifier_str_mv |
Yagi, Tatsuya; Mannheimer, Buster; Reutfors, Johan; Ursing, Johan; Giunta, Diego Hernan; et al.; Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics; Wiley Blackwell Publishing, Inc; British Journal Of Clinical Pharmacology; 89; 2; 2-2023; 887-897 0306-5251 CONICET Digital CONICET |
dc.language.none.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
info:eu-repo/semantics/altIdentifier/doi/10.1111/bcp.15531 info:eu-repo/semantics/altIdentifier/url/https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.15531 |
dc.rights.none.fl_str_mv |
info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by-nc-nd/2.5/ar/ |
eu_rights_str_mv |
openAccess |
rights_invalid_str_mv |
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/ |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Wiley Blackwell Publishing, Inc |
publisher.none.fl_str_mv |
Wiley Blackwell Publishing, Inc |
dc.source.none.fl_str_mv |
reponame:CONICET Digital (CONICET) instname:Consejo Nacional de Investigaciones Científicas y Técnicas |
reponame_str |
CONICET Digital (CONICET) |
collection |
CONICET Digital (CONICET) |
instname_str |
Consejo Nacional de Investigaciones Científicas y Técnicas |
repository.name.fl_str_mv |
CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
repository.mail.fl_str_mv |
dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
_version_ |
1844613957610897408 |
score |
13.070432 |