Key result
Co-prescription of antibiotics in patients on chronic warfarin therapy without close INR monitoring led to severe INR elevation (>10) and major hemorrhagic complications in four cases.
Why the study?
Does the concomitant use of antibiotics and warfarin increase the risk of major bleeding in patients on chronic anticoagulation?
Case Report (n=4)
Does the concomitant use of antibiotics and warfarin increase the risk of major bleeding in patients on chronic anticoagulation?
Co-prescription of antibiotics in patients on chronic warfarin therapy without close INR monitoring can lead to severe over-anticoagulation and life-threatening major bleeding.
Alerts clinicians to monitor INR closely with antibiotic co-prescription in warfarin patients; leaves open interaction magnitude pending prospective data.
Warfarin is a widely used anticoagulant agent with a large spectrum of indications for prevention and treatment of thromboembolic complications. Despite its low cost, warfarin and all other vitamin K antagonist (VKA) use has several limitations, including narrow therapeutic index requiring frequent laboratory monitoring to prevent complications related to under- and over-anticoagulation. The concomitant use of medications may alter the metabolism of warfarin by inducing or inhibiting the cytochrome P450-2C9, resulting in a decrease or increase in anticoagulant effect. In this setting, interactions between warfarin and antibiotics have been described. These interactions represent one of the problems with VKA use in the clinical setting. We aimed to report four cases where the prescription of antibiotics without proper control of anticoagulation levels led to major hemorrhagic complications.
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Marchesan et al. (2018) conducted a case report in Warfarin-related major bleeding (n=4). Antibiotic and warfarin co-prescription was evaluated on Major bleeding and INR elevation. Co-prescription of antibiotics in patients on chronic warfarin therapy without close INR monitoring led to severe INR elevation (>10) and major hemorrhagic complications in four cases.
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