The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis - PubMed (original) (raw)

Meta-Analysis

The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis

Ian Wee et al. Sci Rep. 2021.

Abstract

Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysisattempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71-3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59-2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13-1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the "number needed-to-harm" analysis, 7246 (95% CI: 4329 to 14,085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Figure 1

PRISMA flow diagram.

Figure 2

Figure 2

Association between fluoroquinolone use and aortic dissection.

Figure 3

Figure 3

Association between fluoroquinolone use and aortic aneurysm.

Figure 4

Figure 4

Association between fluoroquinolone use and aortic dissection or aortic aneurysm.

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