Fluoroquinolones up risk of surgery, death in patients with aortic dissection, aneurysm

Exposure to fluoroquinolone (FQ) in patients with aortic dissection (AD) and aneurysm (AA) appears to increase the risk of adverse outcomes compared with amoxicillin use, a study has shown.

“Recent population-based studies have revealed that the use of FQs is associated with an increased risk of AD and AA,” the investigators said.

To test this finding, a retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. The investigators identified a total of 32,570 adult patients who survived after admission for AD or AA between 2001 and 2013.

Each calendar year was then divided into six data units (2 months) for each patient and each year during follow-up. Covariates and exposure of interest were re-evaluated every 2 months. Finally, another common antibiotic, amoxicillin, was used as a negative control exposure.

Exposure to FQs correlated with a higher risk of all-cause death (adjusted hazard ratio [aHR], 1.61, 95 percent confidence interval [CI], 1.50–1.73), aortic death (aHR, 1.80, 95 percent CI, 1.50–2.15), and later aortic surgery. Amoxicillin, on the other hand, was not significantly associated with the risk of any of these outcomes.

In a subgroup analysis, the effect of FQs was not significantly different between patients with AD and AA.

“FQs should not be used by high-risk patients unless no other treatment options are available,” the investigators said.