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
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/220055
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/220055
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling 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 Técnicas2025-10-22T11:38:32Zoai: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:34982025-10-22 11:38:32.373CONICET 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
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score 12.982451

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