The effect of drug interactions on bleeding risk associated with warfarin therapy in hospitalized patients
Open accessAbstract
BACKGROUND: Bleeding is a serious adverse drug reaction associated with warfarin therapy, often induced by interacting co-medication. METHODS: We investigated the frequency and clinical consequences of warfarin drug interactions utilizing medical records of 6,772 warfarin-treated in-patients of Turku University Hospital. RESULTS: A total of 48% of warfarin-treated in-patients were exposed to interacting co-medication. Adjusted odds ratio (OR) for bleeding was highest for cytochrome P450 2C9 (CYP2C9) inhibitors (OR 3.6; 95% confidence interval (CI) 2.4-5.6). Non-selective non-steroidal anti-inflammatory drugs (NSAID) and coxibs were associated with a bleeding risk of a similar magnitude (OR 2.6; 95% CI 1.6-4.2 and OR 3.1; 95% CI 1.4-6.7, respectively). Selective serotonin re-uptake inhibitors (SSRI) were associated with a remarkably higher bleeding risk than non-SSRIs (OR 2.6; 95% CI 1.5-4.3 and OR 1.2; 95% CI 0.3-4.3, respectively). Odds ratio for bleeding in the platelet aggregation inhibitor group was 1.6 (95% CI 0.8-3.1). CONCLUSION: We conclude that co-medication in warfarin-treated in-patients is common and should be carefully evaluated to decrease the bleeding risk associated with warfarin therapy.
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Three studies showed that the bleeding risk increased with low-dose aspirin or NSAID.
“Three studies further showed that the bleeding risk increased with low-dose aspirin or NSAID.192021”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [19]
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- Authors
- Hauta-Aho, M., Tirkkonen, T., Vahlberg, T., & Laine, K.
- Affiliations
- University of Turku (FI)
- Turku University Hospital (FI)
- Venue
- Annals of Medicine
- Publisher
- Informa UK Limited
- Published
- 2009-01
- Volume
- 41
- Issue
- 8
- Pages
- 619-628
- ISSN
- 0785-3890 (ISSN-L)
- 1365-2060
- OpenAlex
- W1978773847
- Cited by
- 67
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 1 · 2016: 2 · 2015: 8 · 2014: 4 · 2013: 5 · 2012: 11
- FWCI
- 5.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Suomen Kulttuurirahasto
- Turun Yliopistollinen Keskussairaala
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- warfarin, drug interactions, bleeding risk, concomitant medications, nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, selective serotonin reuptake inhibitors, antiplatelet agents, hospitalized patients, anticoagulation
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Anticoagulants, Antidepressive Agents, Aryl Hydrocarbon Hydroxylases, Drug Interactions, Enzyme Inhibitors, Female, Finland, Hemorrhage, Hospitalization, Hospitals, University, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors, Warfarin, Case-Control Studies, Databases, Factual, Young Adult, Cytochrome P-450 CYP2C9
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