Fluoroquinolone (FQ) exposure was associated with an increased risk for mortality and adverse outcomes among patients with aortic dissection (AD) or aortic aneurysm (AA), according to results of a retrospective cohort study, published in the Journal of the American College of Cardiology.

Investigators analyzed patient claims data included in Taiwan’s National Health Insurance Research Database for this study. They assessed all patients (N=31,570) with AD or AA between 2001 and 2013 for drug exposure and clinical outcomes.

Patients with AD (42.7%) and AA (57.3%) were a mean age of 70.2 years; 72.6% were male; 76.2% had hypertension; and 24.4% underwent aortic surgery. Patients with AA were older (74.9 vs 63.8 years) and fewer underwent surgery (22.4% vs 27.2%) than patients with AD, respectively.


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From 2001 to 2013, instance of AD (4.4% vs 6.9%; P <.001) and AA (6.5% vs 9.9%; P <.001) increased over time as did prescriptions for FQs (3.6% vs 11.5%; P <.001) and amoxicillin (7.1% vs 8.8%; P <.001). Almost a quarter of patients (23.5%) received prescriptions to FQs, and more than a third (36.2%) received prescriptions for amoxicillin.

All-cause mortality occurred at a rate of 129.5 events/1000 PY.

Patients exposed to FQs were at increased risk for all-cause mortality (adjusted hazard ratio [aHR], 1.61 [95% CI, 1.5-1.73]); aortic death (aHR, 1.8 [95% CI, 1.5-2.15]); undergoing aortic open heart surgery (aHR, 1.49 [95% CI, 1.24-1.79]); and receiving an aortic stent (aHR, 1.64 [95% CI, 1.3-2.06]).

Among patients who had an infection during follow-up, FQ exposure increased risk for all-cause mortality (aHR, 1.31 [95% CI, 1.18-1.46]) and aortic death (aHR, 1.58 [95% CI, 1.22-2.05]) but not for open heart surgery or receiving a stent.

The investigators observed no significant group differences for risk for primary outcomes when stratified by AD or AA status,.

This study may have been limited by not having access to data about adherence to prescriptions.

These data indicated patients with AD or AA had poorer outcomes with FQ exposure. The study authors recommended against use of FQs among these high-risk patient populations.

Reference

Chen SW, Chan YH, Chien-Chia Wu V, et al. Effects of fluoroquinolones on outcomes of patients with aortic dissection or aneurysm. J Am Coll Cardiol. 2021;77(15):1875-1887.