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Use of Fluoroquinolones and Aortic Dissection or Aortic Aneurysm
Quick Takes
- The use of fluoroquinolones should be avoided in patients at risk for or who have existing aortic disease unless benefit outweighs the risk.
- Until further data are available, caution should be exercised in patients with genetic forms of aortopathy as well as in those at risk for heart valve abnormalities.
Study Questions:
What is the association between the use of fluoroquinolones and the risk of adverse events and death in patients with aortic disease?
Methods:
This was a retrospective cohort study in patients admitted for aortic disease that included either aortic dissection or aortic aneurysm who were identified using data from Taiwan’s National Health Research Database between January 1, 2001, and December 13, 2013. A total of 31,570 patients was included. The investigators divided each calendar year after the discharge date from the index aortic aneurysm or aortic dissection into 6 data units. An analytic data unit of 2 months was selected due to the typical refill length of prescriptions for chronic illnesses. Covariates and the exposure of interest (fluoroquinolones or amoxicillin) were evaluated every 2 months where amoxicillin served as a negative control. Exposure was defined as at least 3 prescription days within 2 months prior to the index event where amoxicillin served as a negative control. The study included 4 outcomes: aortic death, all-cause death, aortic stent, and aortic open surgery.
Results:
The 31,570 patients represented a total of 109,359 person years, with a follow-up duration of 3.46 years. Following adjustment for covariates, the results demonstrated that exposure to fluoroquinolones was associated with a higher risk of all-cause death (adjusted hazard ratio [HR] 1.61; confidence interval [CI] 1.5-1.73) and was also associated with a higher risk of aortic death (adjusted HR 1.80; CI 1.5-2.15), higher risk of aortic open surgery (adjusted HR 1.49; CI 1.24-1.79), and aortic stent (adjusted HR 1.64; CI 1.30-2.06). A subgroup analysis showed no difference in the effect of fluoroquinolones between those with aortic dissection or aortic aneurysm. There was no significant in risk in those patients exposed to amoxicillin.
Conclusions:
This study revealed that exposure to fluoroquinolones in patients with aortic disease resulted in a higher risk of adverse outcomes.
Perspective:
This study was conducted in an East Asian population; therefore, the applicability of these results to other populations is unknown. However, other studies have shown an association between fluoroquinolone use and a higher risk of connective tissue disorders within the cardiovascular system that includes not only the aorta but also heart valves. As a result, the US Food and Drug Administration warns against the use of this class of agents in patients who are at risk or who have an aortic aneurysm, have high blood pressure, are elderly, or have Marfan syndrome or Ehlers-Danlos syndrome unless benefit outweighs the risk. Additionally, the European Medicines Agency also warns against the use of fluoroquinolones in patients at increased risk of heart valve regurgitation/incompetence and advises to avoid use in patients with or at risk for valve abnormalities.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Vascular Medicine, Aortic Surgery, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, Novel Agents, Statins
Keywords: Fluoroquinolones, Aortic Aneurysm, Aneurysm, Dissecting, Aortic Diseases, Aorta, Heart Valves, Amoxicillin, Ehlers-Danlos Syndrome, Marfan Syndrome
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