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Purpose: Incidence of bleeding amongst warfarin and direct oral anticoagulant (DOAC) users is greater following a respiratory tract infection (RTI). It is unclear whether immediate antibiotics modify this association. We estimated the risk of bleeding amongst warfarin and DOAC users with RTI by antibiotic treatment.

Methods: This retrospective cohort study used data from the Clinical Practice Research Datalink (CPRD) GOLD for adults in England prescribed warfarin or a DOAC, who sought primary care for an RTI between 1st January 2011 and 31st December 2019. Outcomes were major bleeding (hospital admission for intracranial or gastrointestinal bleeding), and non-major bleeding (hospital admission or General Practice consult for epistaxis, haemoptysis, or haematuria). Cox models derived hazard ratios (HRs) and 95% confidence intervals (CIs) for each outcome, adjusting for confounders using inverse probability of treatment weighting.

Results: Of 14 817 warfarin and DOAC users consulting for an RTI, 8768 (59%) were prescribed immediate antibiotics and 6049 (41%) were not. Approximately 49% were female, and median age was 76 years. Antibiotics were associated with reduced risk of major bleeding (adjusted HR 0.38, 95% CI 0.25 to 0.58). This was consistent across several sensitivity analyses. Antibiotics were also associated with a reduced risk of non-major bleeding (adjusted HR 0.78, 95% CI 0.61 to 0.99).

Conclusions: Immediate antibiotics were associated with reduced risk of bleeding amongst warfarin and DOAC users with an RTI. Further work is needed to understand mechanisms and confirm whether a lower threshold for antibiotic use for RTI in this population may be beneficial.

Titel:	Risk of bleeding amongst warfarin and direct oral anticoagulant users prescribed immediate antibiotics for respiratory tract infection: Cohort study.
Autor/in / Beteiligte Person:	Ahmed, H ; Reeve, N ; Farewell, D ; Hamilton, F ; Ponsford, M ; Hippisley-Cox, J ; Noble, S
Link:	Zum Volltext
Zeitschrift:	Pharmacoepidemiology and drug safety, Jg. 33 (2024-05-01), Heft 5, S. e5794
Veröffentlichung:	Chichester, West Sussex : Wiley, 1992-, 2024
Medientyp:	academicJournal
ISSN:	1099-1557 (electronic)
DOI:	10.1002/pds.5794
Schlagwort:	Humans Female Male Retrospective Studies Aged Middle Aged Aged, 80 and over Cohort Studies England epidemiology Incidence Administration, Oral Warfarin adverse effects Warfarin administration & dosage Respiratory Tract Infections drug therapy Respiratory Tract Infections epidemiology Anti-Bacterial Agents adverse effects Anti-Bacterial Agents administration & dosage Anti-Bacterial Agents therapeutic use Anticoagulants adverse effects Anticoagulants administration & dosage Hemorrhage chemically induced Hemorrhage epidemiology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [Pharmacoepidemiol Drug Saf] 2024 May; Vol. 33 (5), pp. e5794. MeSH Terms: Warfarin* / adverse effects ; Warfarin* / administration & dosage ; Respiratory Tract Infections* / drug therapy ; Respiratory Tract Infections* / epidemiology ; Anti-Bacterial Agents* / adverse effects ; Anti-Bacterial Agents* / administration & dosage ; Anti-Bacterial Agents* / therapeutic use ; Anticoagulants* / adverse effects ; Anticoagulants* / administration & dosage ; Hemorrhage* / chemically induced ; Hemorrhage* / epidemiology ; Humans ; Female ; Male ; Retrospective Studies ; Aged ; Middle Aged ; Aged, 80 and over ; Cohort Studies ; England / epidemiology ; Incidence ; Administration, Oral References: Anticoagulants, including non‐vitamin K antagonist oral anticoagulants (NOACs). Guidance and guidelines. 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Risk of bleeding amongst warfarin and direct oral anticoagulant users prescribed immediate antibiotics for respiratory tract infection: Cohort study.