Fluoroquinolone Risk in Known Aortic Dissection-Aortic Aneurysm Patients

Written by Clay Smith

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Fluoroquinolone (FQ) use in patients with known aortic dissection (AD) or aortic aneurysm (AA) was associated with an increased risk of all-cause mortality, aortic death, and need for aortic surgery.

Why does this matter?
FQs have been associated with aortic dissection before in a Swedish population database study and a Taiwanese population study. However, there may be confounding by indication in these studies. What about patients with known aortic dissection or aneurysm?

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This was a large Taiwanese population database that explored FQ use in 31,570 patients with known pre-existing AD/AA. They looked at 2 month blocks of time and compared each patient to themselves (not exposed to FQ vs exposed to FQ) and they compared periods of FQ exposure to periods of amoxicillin exposure. They found that FQ exposure was associated with all cause mortality and aortic-related death when comparing each patient as their own control: (aHR 1.61 95%CI 1.50 to 1.73), aortic death (aHR 1.80, 95%CI 1.50 to 2.15). Amoxicillin use was also studied in these patients, and no association was found with any of the outcome measures. Again, confounding could be at play in these results. However, I plan to choose an alternative antibiotic in patients with AD/AA if at all possible.

Source
Effects of Fluoroquinolones on Outcomes of Patients With Aortic Dissection or Aneurysm. J Am Coll Cardiol. 2021 Apr 20;77(15):1875-1887. doi: 10.1016/j.jacc.2021.02.047.