Fluoroquinolones Associated With Increased Risk of Aortic Dissection, Aneurysm

Use of fluoroquinolones may be associated with a higher risk of aortic dissection (AD) and aortic aneurysm (AA), according to a study published April 12 in the Journal of the American College of Cardiology.

Shao-Wei Chen, MD, PhD, et al., evaluated the association between use of fluoroquinolones and aortic-related adverse events and death in 31,570 patients in Taiwan who were admitted to the hospital with aortic disease between 2001 and 2013. The researchers looked at patient exposure to fluoroquinolones and amoxicillin, another common antibiotic, as a control exposure during the follow-up period. The study’s four outcomes were all-cause death, aortic death, aortic open surgery and aortic stent.

Of the 31,570 patients, 13,495 (42.7%) were diagnosed with AD and 18,075 (57.3%) were diagnosed with AA. Patients had a mean age of 70.2 years and the majority (72.6%) of patients were male. A total of 7,709 patients (24.4%) received aortic surgery during the index hospital admission.

In primary analysis, exposure to fluoroquinolones was associated with a higher risk of all-cause death (adjusted hazard ratio [aHR]: 1.61; 95% confidence interval [CI]: 1.50-1.73) and higher risk of aortic death (aHR: 1.80; 95% CI: 1.50-2.15). In addition, exposure to fluoroquinolones was associated with a greater likelihood of requiring aortic open surgery (aHR: 1.49; 95% CI: 1.24 to 1.79) and an aortic stent (aHR: 1.64; 95% CI: 1.30 to 2.06). Exposure to amoxicillin was not significantly associated with these outcomes. In secondary analysis, risks of the four outcomes were significantly higher with fluoroquinolone exposure vs. amoxicillin exposure. The increased risk was not significantly different among patients with AD vs. AA or in patients who received aortic surgery in the index admission vs. those who did not.

According to the researchers, compared with amoxicillin, fluoroquinolone exposure was associated with a higher risk of later all-cause mortality, aortic-related death and later aortic surgery in patients with AD or AA. They suggest that clinicians “carefully weigh the benefits against the potential harm of fluoroquinolones,” concluding that fluoroquinolones “should not be used in patients with AD or AA unless no other treatment options are available.”

The study “represents an important contribution to the growing body of evidence supporting concerns that fluoroquinolones have a detrimental effect on the aortic wall,” Scott A. LeMaire, MD, writes in an accompanying editorial comment. Additional research is “clearly needed to improve our understanding of the scope of the risk and the ideal approach to changing clinical practice,” he writes.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Aortic Surgery, Novel Agents, Statins, Interventions and Vascular Medicine

Keywords: Fluoroquinolones, Amoxicillin, Aortic Rupture, Anti-Bacterial Agents, Taiwan, Confidence Intervals, Follow-Up Studies, Aortic Aneurysm, Aneurysm, Dissecting, Aortic Diseases, Aorta, Hospitals, Stents, ACC International

< Back to Listings