Coagulopathy Caused by Concurrent Ciprofloxacin and Warfarin Use: What Other Factors Induce Coagulopathy?

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Coagulopathy during concurrent warfarin and ciprofloxacin use (n=28). Intervention: Prolonged INR (>5.0) during concurrent warfarin and ciprofloxacin use vs. Normal INR (<3.5). Primary outcome: Mean Activities of Daily Living (ADL) score (p=<0.001).

Sungmo Jung; Misung Park; Won Jin Kim; Chang Oh Kim

doi:10.4235/jkgs.2013.17.1.47

March 31, 2013Journal of the Korean Geriatrics SocietyOpen Access

Coagulopathy Caused by Concurrent Ciprofloxacin and Warfarin Use: What Other Factors Induce Coagulopathy?

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Key result

Higher Activities of Daily Living (ADL) scores and a greater number of medication classes were associated with prolonged INR in patients concurrently using warfarin and ciprofloxacin.

Why the study?

Does poor general condition increase the risk of INR prolongation in patients taking concurrent warfarin and ciprofloxacin?

Study Design

Type

Case-Control (n=28)

Multicenter

No

Structured PICO

Does poor general condition increase the risk of INR prolongation in patients taking concurrent warfarin and ciprofloxacin?

P

Population

28 hospitalized patients taking concurrent warfarin and ciprofloxacin, including 9 cases with prolonged INR (>5.0) and 19 controls with normal INR (<3.5).

E

Exposure

Poor general condition (indicated by high Activities of Daily Living [ADL] scores and polypharmacy)

C

Comparator

Better general condition (lower ADL scores and fewer medications)

O

Outcome

Prolongation of international normalized ratio (INR) >5.0 without an increase in warfarin dosesafety

Main Result

Absolute Event Rate: 15.33% vs 7.11%

p-value: p=<0.001

In patients taking concurrent warfarin and ciprofloxacin, poor general condition (reflected by higher ADL scores and polypharmacy) is significantly associated with an increased risk of severe coagulopathy.

Limitations

Single-center, retrospective, non-randomized study design leading to possible selection bias
Small sample size (9 cases and 19 controls) limits generalizability
Uncontrolled and unquantified dietary vitamin K intake
Lack of objective guidelines to define INR prolongation, necessitating arbitrary cutoffs (>5.0 for cases, <3.5 for controls)
Single-center study
Not a randomized study (potential selection bias)
Small sample size (9 cases, 19 controls)
Uncontrolled and unquantified vitamin K intake from general hospital diets

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Suggests heightened INR monitoring in frail or polypharmacy patients on warfarin plus ciprofloxacin; leaves open whether poor general condition is causal.

Abstract

Background: To assess factors affecting the prolongation of the international normalized ratio (INR) with concurrent warfarin and ciprofloxacin use. Methods: A retrospective case-control study was performed at a single, 2,000-bed tertiary hospital between January 2007 and December 2009. Thirty-three patients who were on warfarin and ciprofloxacin concurrently were enrolled. Demographics and clinical data were collected from medical records. Results: Nine patients were assigned to the case group (prolonged INR) and 19 patients to the control group (normal INR). Activities of daily living (ADL) and total number of classes of medications taken demonstrated significant differences between the groups (15.33 vs. 7.11, p<0.001; 7.11 vs. 5.47, p=0.041). No bleeding complications occurred during this study.

Discussion

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Cite This Study

Jung et al. (2013) conducted a case-control in Coagulopathy during concurrent warfarin and ciprofloxacin use (n=28). Prolonged INR (>5.0) during concurrent warfarin and ciprofloxacin use vs. Normal INR (<3.5) was evaluated on Mean Activities of Daily Living (ADL) score (p=<0.001). Higher Activities of Daily Living (ADL) scores and a greater number of medication classes were associated with prolonged INR in patients concurrently using warfarin and ciprofloxacin.

synapsesocial.com/papers/6a94113901d6912b871d53d3 https://doi.org/10.4235/jkgs.2013.17.1.47

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Coagulopathy Caused by Concurrent Ciprofloxacin and Warfarin Use: What Other Factors Induce Coagulopathy?

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Coagulopathy Caused by Concurrent Ciprofloxacin and Warfarin Use: What Other Factors Induce Coagulopathy?

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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