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. 2018 Mar 8:360:k678.
doi: 10.1136/bmj.k678.

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

Björn Pasternak  1   2 , Malin Inghammar  2   3 , Henrik Svanström  2
Affiliations

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

Björn Pasternak et al. BMJ. .

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 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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Nationwide cohort of patients in Sweden with treatment episodes of fluoroquinolone use and amoxicillin use, 2006-13. Values for exclusion criteria do not add up to totals because some episodes were excluded for more than one reason
Fig 2
Fig 2
Cumulative incidence of aortic aneurysm or dissection within 60 day risk period from start of study treatment
See this image and copyright information in PMC

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