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Fluoroquinolone use and risk of aortic aneurysm and dissection : Nationwide cohort study

Pasternak, Björn LU ; Inghammar, Malin LU and Svanström, Henrik (2018) In BMJ (Online) 360.
Abstract

Objective To investigate whether oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection. Design Nationwide historical cohort study using linked register data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection. Setting Sweden, July 2006 to December 2013. Participants 360 088 treatment episodes of fluoroquinolone use (78%ciprofloxacin) and propensity score matched comparator episodes of amoxicillin use (n=360 088). Main outcome measures Cox regression was used to estimate hazard ratios for a first diagnosis of aortic aneurysm or dissection, defined as admission to hospital or emergency department for, or death due to, aortic aneurysm or dissection, within 60... (More)

Objective To investigate whether oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection. Design Nationwide historical cohort study using linked register data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection. Setting Sweden, July 2006 to December 2013. Participants 360 088 treatment episodes of fluoroquinolone use (78%ciprofloxacin) and propensity score matched comparator episodes of amoxicillin use (n=360 088). Main outcome measures Cox regression was used to estimate hazard ratios for a first diagnosis of aortic aneurysm or dissection, defined as admission to hospital or emergency department for, or death due to, aortic aneurysm or dissection, within 60 days from start of treatment. Results Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection. Conclusions In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm.

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author
organization
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type
Contribution to journal
publication status
published
subject
in
BMJ (Online)
volume
360
pages
8 pages
publisher
BMJ Publishing Group
external identifiers
  • scopus:85043590556
ISSN
0959-8146
DOI
10.1136/bmj.k678
language
English
LU publication?
yes
id
71a8602b-aee0-4670-8120-7e9a05395c0d
date added to LUP
2018-04-03 11:31:00
date last changed
2018-09-23 04:56:37
@article{71a8602b-aee0-4670-8120-7e9a05395c0d,
  abstract     = {<p>Objective To investigate whether oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection. Design Nationwide historical cohort study using linked register data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection. Setting Sweden, July 2006 to December 2013. Participants 360 088 treatment episodes of fluoroquinolone use (78%ciprofloxacin) and propensity score matched comparator episodes of amoxicillin use (n=360 088). Main outcome measures Cox regression was used to estimate hazard ratios for a first diagnosis of aortic aneurysm or dissection, defined as admission to hospital or emergency department for, or death due to, aortic aneurysm or dissection, within 60 days from start of treatment. Results Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection. Conclusions In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm.</p>},
  articleno    = {k678},
  author       = {Pasternak, Björn and Inghammar, Malin and Svanström, Henrik},
  issn         = {0959-8146},
  language     = {eng},
  month        = {03},
  pages        = {8},
  publisher    = {BMJ Publishing Group},
  series       = {BMJ (Online)},
  title        = {Fluoroquinolone use and risk of aortic aneurysm and dissection : Nationwide cohort study},
  url          = {http://dx.doi.org/10.1136/bmj.k678},
  volume       = {360},
  year         = {2018},
}