Fluroquinolones raise risk for adverse events in patients with aortic dissection, aneurysm
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Patients with aortic dissection or aneurysm prescribed fluroquinolones had elevated risk for adverse outcomes, according to a study published in the Journal of the American College of Cardiology.
There was no elevated risk for adverse outcomes as a result of amoxicillin use in this population, the researchers wrote.
“Clinicians should carefully weigh the benefits against the potential harm of fluroquinolones for treating patients with aortic dissection or aortic aneurysm. Fluroquinolones should not be used in patients with aortic dissection or aortic aneurysm unless no other treatment options are available,” Shao-Wei Chen, MD, with the division of thoracic and cardiovascular surgery, department of surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, and colleagues wrote.
Researchers analyzed 31,570 hospitalized patients (mean age, 70 years) who had aortic dissection or aortic aneurysm. Among the cohort, 23.6% were prescribed fluoroquinolones and 36.2% were prescribed amoxicillin during the study period of 2001 to 2013.
During a mean follow-up of 3.46 years, patients who were exposed to fluroquinolones had higher risk for all-cause death (adjusted HR = 1.61; 95% CI, 1.5-1.73) and aortic death (aHR = 1.8; 95% CI, 1.5-2.15) compared with those who were not exposed, according to the researchers.
The researchers also found fluroquinolone exposure was linked to higher risk for needing an aortic stent procedure (aHR = 1.64; 95% CI, 1.3-2.06) and aortic open surgery (aHR = 1.49; 95% CI, 1.24-1.79).
However, amoxicillin use was not associated with any adverse outcomes in the study population.
“The report by Chen et al represents an important contribution to the growing body of evidence supporting concerns that fluoroquinolones have a detrimental effect on the aortic wall. Further laboratory and clinical studies are clearly needed to improve our understanding of the scope of the risk and the ideal approach to changing clinical practice,” Scott A. LeMaire, MD, professor and vice chair for research in the Michael E. DeBakey department of surgery, Baylor College of Medicine, wrote in a related editorial.
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