Effects of Fluoroquinolones on Outcomes of Patients With Aortic Dissection or Aneurysm.

Background: Recent population-based studies have revealed that the use of fluoroquinolones (FQs) is associated with an increased risk of aortic dissection (AD) and aneurysm (AA). However, no evidence is available on whether FQs increase adverse events in patients who had been diagnosed with AD or AA.
Objectives: This study investigated whether the use of FQs increases the risk of aortic-related adverse events and death in this high-risk population.
Methods: A retrospective cohort study was conducted by using the Taiwan National Health Insurance Research Database. A total of 31,570 adult patients who survived after admission for AD or AA between 2001 and 2013 were identified. We divided each calendar year into 6 data units (2 months) for each patient and each year during follow-up. Covariates and exposure of interest (FQs) were reassessed every 2 months. We used another common antibiotic, amoxicillin, as a negative control exposure.
Results: Exposure to FQs was associated with a higher risk of all-cause death (adjusted hazard ratio: 1.61; 95% confidence interval: 1.50 to 1.73), aortic death (adjusted hazard ratio: 1.80; 95% confidence interval: 1.50 to 2.15), and later aortic surgery. However, amoxicillin exposure was not significantly associated with risk of any of the outcomes. A subgroup analysis revealed that the effect of FQs was not significantly different between the AD and AA groups.
Conclusions: Relative to amoxicillin use, FQ exposure in patients with AD or AA was associated with a higher risk of adverse outcomes. FQs should not be used by high-risk patients unless no other treatment options are available.
Competing Interests: Funding Support and Author Disclosures This work was supported by a grant from Chang Gung Memorial Hospital, Taiwan: CMRPG3K1951, CMRPG3J0661, CMRPG3L0101 and BMRPD95 (to Dr. Chen). This work was also supported by the Ministry of Science and Technology grant MOST-108-2314-B-182A-141 (to Dr. Chen). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)