Key result
Fluoroquinolones added to warfarin are linked to sharp INR elevations, unlike cefixime.
Why the study?
The interaction of warfarin with moxifloxacin and levofloxacin leading to significant increases in INR levels and coagulopathies remains debated.
Does the addition of levofloxacin or moxifloxacin compared to cefixime increase INR levels in patients on warfarin after metallic valve replacement?
Observational (n=75)
No
Does the addition of levofloxacin or moxifloxacin compared to cefixime increase INR levels in patients on warfarin after metallic valve replacement?
In patients on warfarin after metallic valve replacement, adding levofloxacin or moxifloxacin significantly increases INR compared to cefixime, suggesting cefixime is a safer antibiotic choice to prevent coagulopathies.
Associated INR rise with levofloxacin/moxifloxacin in post-valve warfarin patients warrants caution; leaves open cefixime preference pending randomized trials.
Background and Objectives: A dispute over interaction of warfarin with two quinolones—i.e., moxifloxacin and levofloxacin—leading to significant increase in international normalized ratio (INR) levels and coagulopathies is currently in debate. The study objective was to compare the INR values due to addition of quinolones and cefixime in warfarin treated patients after replacement of disease valves with metallic valves. Material and Methods: A prospective evaluation of patients who undergone valve replacement surgeries in the cardiology hospital setup in Pakistan during the period 2018–2019 was done, including all those subjects treated concurrently with levofloxacin, moxifloxacin, cefixime, and warfarin for the study. Data organized included demographic information, concurrent medications, and appropriate analytical parameters, especially INR values taken before and within seven days after prescribing three antibiotics in discharged patients who had undergone valve replacement surgeries. Patients for whom laboratory INR values were not given at the time of discharge and with deranged liver function, renal function, low albumin levels, and febrile patients were removed from study. Furthermore, patients were advised on possible food interactions and evaluated to examine if these factors have any possible influence on the interaction being studied. Results: Differences in INR were analyzed statistically by means of SPSS analysis before and after the possible interaction. Following the administration of levofloxacin and moxifloxacin to warfarin therapy, statistical analysis showed remarkable increase in INR (p < 0.001) and no significant change in INR was observed after cefixime treatment (p > 0.05). Conclusion: Results showed that, after adding levofloxacin and moxifloxacin in patients on warfarin, therapy contributed to remarkable increase in INR. However, addition of cefixime prevented frequent coagulopathies; therefore, close monitoring of INR and switching to a safe antibiotic such as cefixime is recommended.
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Liaqat et al. (2019) conducted an observational in Valvular heart disease post valve replacement surgery on warfarin therapy (n=75). Quinolones (Moxifloxacin or Levofloxacin) vs. Cefixime was evaluated on Change in INR levels within 7 days of starting antibiotics (p=<0.001). The addition of moxifloxacin or levofloxacin to warfarin therapy resulted in a significant increase in INR levels to 11.9 ± 3.11 and 10.5 ± 3.1 respectively (p < 0.001 for both before-after comparisons), whereas cefixime did not cause a significant change.
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