Bleeding events attributable to concurrent use of warfarin and other medications in high-risk elderly : meta-analysis and Italian population-based investigation
PURPOSE: The aim of this study was to estimate the proportion of bleedings that occurred among warfarin users attributable to the concomitant use of other medications. A general approach for measuring the impact of the prescriptive inappropriateness on drug adverse outcomes at the population level is described.
METHODS: A meta-analysis was conducted to obtain summary relative risks of bleeding associated with concurrent use of warfarin and other medications compared to warfarin use alone. A population-based investigation was performed, in an Italian cohort of cardiopathic patients aged 65 years or older, to estimate the prevalence of concurrent users of warfarin and other medicaments. The population attributable fraction was computed by combining data on summary relative risks and prevalence of concurrent users.
RESULTS: Concomitant use of warfarin and cotrimoxazole, amiodarone, quinolones, macrolides, platelet aggregation inhibitors, SSRIs, NSAIDs, and lipid-lowering agents was associated with an increased risk of bleeding. The corresponding attributable fractions were 3% (95% CI 2 to 4%), 21% (1 to 41%), 21% (17 to 25%), 9% (8 to 10%), 14% (12 to 16%), 6% (5 to 8%), 10% (1 to 20%), and 8% (0 to 18%), respectively.
CONCLUSIONS: More than half of bleeding events occurring among frail elderly using warfarin are attributable to a concomitant use of warfarin with certain drugs. Because some of these drugs appear to be essential for the treatment/prevention of cardiovascular conditions, and their concomitant use with warfarin could be acceptable in some cases, proper INR-monitoring and warfarin dose adjustments are requested.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:74 |
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| Enthalten in: |
European journal of clinical pharmacology - 74(2018), 8 vom: 07. Aug., Seite 1061-1070 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Comoretto, Rosanna Irene [VerfasserIn] |
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| Links: |
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| Themen: |
5Q7ZVV76EI |
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| Anmerkungen: |
Date Completed 11.09.2019 Date Revised 11.09.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00228-018-2467-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM283838450 |
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| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
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| 041 | |a eng | ||
| 100 | 1 | |a Comoretto, Rosanna Irene |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Bleeding events attributable to concurrent use of warfarin and other medications in high-risk elderly |b meta-analysis and Italian population-based investigation |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 11.09.2019 | ||
| 500 | |a Date Revised 11.09.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: The aim of this study was to estimate the proportion of bleedings that occurred among warfarin users attributable to the concomitant use of other medications. A general approach for measuring the impact of the prescriptive inappropriateness on drug adverse outcomes at the population level is described | ||
| 520 | |a METHODS: A meta-analysis was conducted to obtain summary relative risks of bleeding associated with concurrent use of warfarin and other medications compared to warfarin use alone. A population-based investigation was performed, in an Italian cohort of cardiopathic patients aged 65 years or older, to estimate the prevalence of concurrent users of warfarin and other medicaments. The population attributable fraction was computed by combining data on summary relative risks and prevalence of concurrent users | ||
| 520 | |a RESULTS: Concomitant use of warfarin and cotrimoxazole, amiodarone, quinolones, macrolides, platelet aggregation inhibitors, SSRIs, NSAIDs, and lipid-lowering agents was associated with an increased risk of bleeding. The corresponding attributable fractions were 3% (95% CI 2 to 4%), 21% (1 to 41%), 21% (17 to 25%), 9% (8 to 10%), 14% (12 to 16%), 6% (5 to 8%), 10% (1 to 20%), and 8% (0 to 18%), respectively | ||
| 520 | |a CONCLUSIONS: More than half of bleeding events occurring among frail elderly using warfarin are attributable to a concomitant use of warfarin with certain drugs. Because some of these drugs appear to be essential for the treatment/prevention of cardiovascular conditions, and their concomitant use with warfarin could be acceptable in some cases, proper INR-monitoring and warfarin dose adjustments are requested | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Attributable fraction | |
| 650 | 4 | |a Bleeding risk | |
| 650 | 4 | |a Drug-drug interaction | |
| 650 | 4 | |a Elderly patients | |
| 650 | 4 | |a Warfarin | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Warfarin |2 NLM | |
| 650 | 7 | |a 5Q7ZVV76EI |2 NLM | |
| 700 | 1 | |a Rea, Federico |e verfasserin |4 aut | |
| 700 | 1 | |a Lucenteforte, Ersilia |e verfasserin |4 aut | |
| 700 | 1 | |a Mugelli, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Trifirò, Gianluca |e verfasserin |4 aut | |
| 700 | 1 | |a Cascini, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Roberto, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Chinellato, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Filippelli, Amelia |e verfasserin |4 aut | |
| 700 | 1 | |a Corrao, Giovanni |e verfasserin |4 aut | |
| 700 | 0 | |a Italian Group for Appropriate Drug prescription in the Elderly (I-GrADE) |e verfasserin |4 aut | |
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