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Original Investigation |

Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone

Chien-Chang Lee, MD, ScD1,2,3; Meng-tse Gabriel Lee, PhD1; Yueh-Sheng Chen, MD4; Shih-Hao Lee, MA1; Yih-Sharng Chen, MD, PhD5; Shyr-Chyr Chen, MD, MBA1; Shan-Chwen Chang, MD, PhD6
[+] Author Affiliations
1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
2Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliou, Taiwan
3Department of General Medicine, National Taiwan University Hospital, Yunlin Branch, Douliou, Taiwan
4Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
5Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
6Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
JAMA Intern Med. 2015;175(11):1839-1847. doi:10.1001/jamainternmed.2015.5389.
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Importance  Fluoroquinolones have been associated with collagen degradation, raising safety concerns related to more serious collagen disorders with use of these antibiotics, including aortic aneurysm and dissection.

Objective  To examine the relationship between fluoroquinolone therapy and the risk of developing aortic aneurysm and dissection.

Design, Setting, and Participants  We conducted a nested case-control analysis of 1477 case patients and 147 700 matched control cases 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. One hundred control patients were matched for each case based on age and sex.

Exposures  Current, past, or any prior-year use of fluoroquinolone. Current use was defined as a filled fluoroquinolone prescription within 60 days of the aortic aneurysm or dissection; past use refers to a filled fluoroquinolone prescription between 61 and 365 days prior to the aortic aneurysm; and any prior-year use refers to having a fluoroquinolone prescription filled for 3 or more days any time during the 1-year period before the aortic aneurysm or dissection.

Main Outcomes and Measures  Risk of developing aortic aneurysm or dissection.

Results  A total of 1477 individuals who experienced aortic aneurysm or dissection were matched to 147 700 controls. 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% 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 demonstrated an increased risk associated with current fluoroquinolone use, but the increase was not statistically significant (propensity score–adjusted RR, 2.15; 95% CI, 0.97-4.60).

Conclusions and Relevance  Use of fluoroquinolones was associated with an increased risk of aortic aneurysm and dissection. While these were rare events, physicians should be aware of this possible drug safety risk associated with fluoroquinolone therapy.

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