In the Journals

Fluoroquinolones elevate risk for aortic aneurysm, dissection

Exposure to fluoroquinolones was highly associated with risk for aortic aneurysm and aortic dissection, researchers reported.

The researchers conducted a case-crossover analysis of a Taiwanese national administrative database, focusing on 1,213 patients hospitalized for aortic aneurysm or aortic dissection between 2001 and 2011 and 1,213 matched controls.

For each patient, the researchers compared fluoroquinolone exposure during a 60-day period before aortic aneurysm or aortic dissection diagnosis (hazard period) with exposure during a randomly selected 60-day period within 60 to 180 days before hospitalization (referent period). They performed subsequent analyses to adjust for time-variant confounders and time-trend biases.

In the main analysis, exposure to fluoroquinolones was more frequent during the hazard period than during the referent period (1.6% vs. 0.6%; OR = 2.71; 95% CI, 1.14-6.46).

In a sensitivity analysis adjusted for infections and co-medications, the risk did not change (OR = 2.05; 95% CI, 1.13-3.71).

A longer exposure to fluoroquinolones conferred a greater risk for aortic aneurysm and aortic dissection (3-14 days vs. < 3 days: OR = 2.41; 95% CI, 1.25-4.65; > 14 days vs. < 3 days: OR = 2.83; 95% CI, 1.06-7.57; P for trend < .01).

In a susceptible period analysis, the researchers found exposure to fluoroquinolones within 60 days of aortic aneurysm or aortic dissection diagnosis was associated with high risk for aortic aneurysm or aortic dissection (OR = 2.7; 95% CI, 1.87-21.4) but exposure within 120 or 180 days was not.

In a case-time-control analysis, temporal changes in fluoroquinolone exposure were not related to aortic aneurysm or aortic dissection risk.

“Typically, [aortic aneurysms and aortic dissections] develop slowly in patients, but our data suggest that use of fluoroquinolone can contribute in the short term to aneurysm progression or rupture that may require emergency department visits and hospitalization,” Chien-Chang Lee, MD, ScD, from the department of emergency medicine at National Taiwan University Hospital, Taipei, and colleagues wrote.

In a related editorial, Sonal Singh, MD, MPH, from the department of family medicine and community health, Meyers Primary Care Institute, University of Massachusetts Medical School, and Amit Nautiyal, MD, from the division of pulmonary and critical care medicine, Albany Medical College, wrote: “It would be prudent to entertain the possibly of aortic aneurysms/aortic dissection associated with fluoroquinolones use in patients presenting with chest pain, shortness of breath or syncope after recent exposure to the fluoroquinolones.

“Although one should be careful in extrapolating from mechanistic studies, judicious use

of fluoroquinolones may be particularly warranted among patients with risk factors for aortic aneurysms such as increasing age, the presence of smoking, hypertension and Marfan’s syndrome,” they wrote. “Clinicians should carefully balance the risks of tendon rupture, and aortic aneurysms and aortic dissection associated with fluoroquinolones against their benefits, after considering the importance patients assign to these outcomes in a shared decision-making context.” – by Erik Swain

Disclosure: The authors, Nautiyal and Singh report no relevant financial disclosures.

Exposure to fluoroquinolones was highly associated with risk for aortic aneurysm and aortic dissection, researchers reported.

The researchers conducted a case-crossover analysis of a Taiwanese national administrative database, focusing on 1,213 patients hospitalized for aortic aneurysm or aortic dissection between 2001 and 2011 and 1,213 matched controls.

For each patient, the researchers compared fluoroquinolone exposure during a 60-day period before aortic aneurysm or aortic dissection diagnosis (hazard period) with exposure during a randomly selected 60-day period within 60 to 180 days before hospitalization (referent period). They performed subsequent analyses to adjust for time-variant confounders and time-trend biases.

In the main analysis, exposure to fluoroquinolones was more frequent during the hazard period than during the referent period (1.6% vs. 0.6%; OR = 2.71; 95% CI, 1.14-6.46).

In a sensitivity analysis adjusted for infections and co-medications, the risk did not change (OR = 2.05; 95% CI, 1.13-3.71).

A longer exposure to fluoroquinolones conferred a greater risk for aortic aneurysm and aortic dissection (3-14 days vs. < 3 days: OR = 2.41; 95% CI, 1.25-4.65; > 14 days vs. < 3 days: OR = 2.83; 95% CI, 1.06-7.57; P for trend < .01).

In a susceptible period analysis, the researchers found exposure to fluoroquinolones within 60 days of aortic aneurysm or aortic dissection diagnosis was associated with high risk for aortic aneurysm or aortic dissection (OR = 2.7; 95% CI, 1.87-21.4) but exposure within 120 or 180 days was not.

In a case-time-control analysis, temporal changes in fluoroquinolone exposure were not related to aortic aneurysm or aortic dissection risk.

“Typically, [aortic aneurysms and aortic dissections] develop slowly in patients, but our data suggest that use of fluoroquinolone can contribute in the short term to aneurysm progression or rupture that may require emergency department visits and hospitalization,” Chien-Chang Lee, MD, ScD, from the department of emergency medicine at National Taiwan University Hospital, Taipei, and colleagues wrote.

In a related editorial, Sonal Singh, MD, MPH, from the department of family medicine and community health, Meyers Primary Care Institute, University of Massachusetts Medical School, and Amit Nautiyal, MD, from the division of pulmonary and critical care medicine, Albany Medical College, wrote: “It would be prudent to entertain the possibly of aortic aneurysms/aortic dissection associated with fluoroquinolones use in patients presenting with chest pain, shortness of breath or syncope after recent exposure to the fluoroquinolones.

“Although one should be careful in extrapolating from mechanistic studies, judicious use

of fluoroquinolones may be particularly warranted among patients with risk factors for aortic aneurysms such as increasing age, the presence of smoking, hypertension and Marfan’s syndrome,” they wrote. “Clinicians should carefully balance the risks of tendon rupture, and aortic aneurysms and aortic dissection associated with fluoroquinolones against their benefits, after considering the importance patients assign to these outcomes in a shared decision-making context.” – by Erik Swain

Disclosure: The authors, Nautiyal and Singh report no relevant financial disclosures.