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Oral Fluoroquinolone and Aortic Dissection and Aortic Aneurysm Risk
Study Questions:
Is there a relationship between fluoroquinolone therapy and the risk of developing aortic aneurysm and dissection?
Methods:
A nested case-control analysis was conducted of 1,477 case patients and 147,700 matched control cases (100 control patients for each case, based on age and sex) from Taiwan’s National Health Insurance Research Database (NHIRD) from among 1 million individuals longitudinally observed from January 2000 through December 2011. Cases patients were defined as those hospitalized for aortic aneurysm or dissection. Current (prescription filled within 60 days of aortic aneurysm or dissection), past (prescription filled 61–365 days prior), or any prior-year use of fluoroquinolone (prescription filled for 3 or more days any time during the 1-year period before aortic aneurysm or dissection) was assessed as a possible risk for aortic aneurysm or dissection.
Results:
After propensity score adjustment, current use of fluoroquinolones was found to be associated with increased risk for aortic aneurysm or dissection (rate ratio [RR], 2.43; 95% confidence interval [CI], 1.83-3.22), as was past use, although this risk was attenuated (RR, 1.48; 95% CI, 1.18-1.86). Sensitivity analysis focusing on aortic aneurysm and dissection requiring surgery also suggested an increased risk associated with current fluoroquinolone use, but the trend did not reach statistical significance (propensity score–adjusted RR, 2.15; 95% CI, 0.97-4.60).
Conclusions:
Use of fluoroquinolones was associated with an increased risk of aortic aneurysm and dissection. The authors recommend that, although aortic events were rare, physicians should be aware of this possible drug safety risk associated with fluoroquinolone therapy.
Perspective:
Fluoroquinolones have been associated with collagen degradation, raising safety concerns related to more serious collagen disorders with use of these antibiotics. These data from a large Taiwanese registry suggest that there is a small, but statistically significant increase in risk for aortic aneurysm or dissection detection following therapy with an oral fluoroquinolone.
Keywords: Aneurysm, Dissecting, Anti-Bacterial Agents, Antibiotics, Antitubercular, Aortic Aneurysm, Cardiac Surgical Procedures, Fluoroquinolones, Risk
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