Fluoroquinolone Use May Increase Risk for Aortic Aneurysm and Dissection

Fluoroquinolone use may be associated with an increased risk for aortic aneurysm or dissection, according to a study recently published in the British Medical Journal.

In this nationwide Swedish cohort study, the association between oral fluoroquinolone use and risk for aortic aneurysm or dissection was investigated. Because amoxicillin use is not associated with aortic aneurysm or dissection, admission to hospital or death resulting from aortic aneurysm or dissection associated with oral fluoroquinolone use compared with amoxicillin use within a 60-day period from start of treatment was examined. The source population included adults from Sweden who received a prescription for fluoroquinolones or amoxicillin during the study who were aged 50 years or older. Data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection between 2006 and 2013 were collected.

Use of fluoroquinolones was associated with a 66% increased rate of aortic aneurysm or dissection with a 60-day risk period from start of treatment, which corresponded to an absolute difference of 82 cases/1 million treatment episodes. The hazard ratio (HR) for the association with fluoroquinolone use was 1.90 (95% CI, 1.22-2.96) for aortic aneurysm and 0.93 (95% CI, 0.38-2.29) for aortic dissection.

In a secondary analysis, fluoroquinolone exposure did not increase risk for aortic aneurysm or dissection in the period of 61 to 120 days from start of treatment (HR, 0.67). Furthermore, of 64 cases of aortic aneurysm among fluoroquinolone-treated patients, 26 (41%) occurred within first 10 days of start of treatment.

In subgroup analyses, the HRs with fluoroquinolone use did not differ significantly between women and men or between subgroups of patients aged 50 to 64 years and those aged 65+ years. In addition, the HR for death from any cause associated with fluoroquinolone use compared with amoxicillin was 1.02 (95% CI, 0.97-1.08), whereas the HR for aortic aneurysm or dissection was 1.62 (95% CI, 1.05-2.48).

Study authors concluded that study results support “the notion that fluoroquinolone use could be associated with an increased risk of aortic aneurysm or dissection,” but further scrutiny is required against the benefits of this treatment before recommending other clinical treatments.

Reference

Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678.