PandemieGrippaleV1, Main, Exploration, bibRecord, 001889

Bleeding Events Following Concurrent Use of Warfarin and Oseltamivir by Medicare Beneficiaries

Identifieur interne : 001889 ( Main/Exploration ); précédent : 001888; suivant : 001890

Bleeding Events Following Concurrent Use of Warfarin and Oseltamivir by Medicare Beneficiaries

Auteurs : Andrew D. Mosholder [États-Unis] ; Judith A. Racoosin [États-Unis] ; Stephanie Young [États-Unis] ; Michael Wernecke [États-Unis] ; Azadeh Shoaibi [États-Unis] ; Thomas E. Macurdy [États-Unis] ; Christopher Worrall [États-Unis] ; Jeffrey A. Kelman [États-Unis]

Source :

The Annals of pharmacotherapy [ 1060-0280 ] ; 2013.

RBID : Pascal:14-0023240

Descripteurs français

Pascal (Inist)
- Hémorragie, Simultané, Warfarine, Oséltamivir, Assurance maladie, Interaction médicamenteuse, Grippe, Homme, Anticoagulant, Antiviral.
Wicri :
- topic : Assurance maladie, Homme.

English descriptors

KwdEn :
- Anticoagulant, Antiviral, Concurrent, Drug interaction, Health insurance, Hemorrhage, Human, Influenza, Oseltamivir, Warfarin.

Abstract

Background: During the 2009 HINI influenza pandemic, the UK Medicines and Healthcare Products Regulatory Agency received case reports suggesting a potentiation of warfarin anticoagulation by the antiviral drug oseltamivir. We evaluated this putative interaction using Medicare data. Objective: To determine the frequency of bleeding following addition of oseltamivir or comparator drugs among Medicare beneficiaries taking warfarin. Methods: This was a retrospective cohort evaluation using Medicare nationwide data. Cohort members were Medicare Parts A, B, and D beneficiaries from June 30, 2006 to October 31, 2010 receiving warfarin for at least I month prior to a concomitant drug of interest (oseltamivir, ampicillin, trimethoprim-sulfamethoxazole (TMP-SMX), and angiotensin-converting enzyme (ACE) inhibitors). Bleeding within 14 days of new prescriptions for oseltamivir or comparators was identified using inpatient or emergency department ICD-9 (International Classification of Diseases, ninth revision) discharge diagnosis codes for gastrointestinal hemorrhage, epistaxis, hematuria, and intracranial bleeding. Patients with bleeding within 30 days preceding the prescription concomitant to warfarin were excluded. Results: With concomitant ACE inhibitors as reference, adjusted odds ratios (ORs) for any bleeding events within 14 days were 1.47 (95% confidence interval [Cl] = 1.08-1.88), 1.24 (95% Cl = 0.97-1.57), and 2.74 (95% Cl = 2.53-3.03), for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. In a sensitivity analysis, adjusted ORs over a 7-day period were 1.89 (95% Cl = 1.29-2.59), 1.47 (95% Cl = 1.06-2.02), and 3.07 (95% Cl = 2.76-3.49) for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. Conclusions: Bleeding with oseltamivir plus warfarin was not significantly increased over a 14-day observation period; a sensitivity analysis showed a statistically significant increase over a 7-day period; in contrast, the data consistently showed the known tendency of TMP-SMX to potentiate the effects of warfarin. The results should be interpreted with the limitations of this approach in mind, including the inability to control for unmeasured confounders.

Affiliations:

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Le document en format XML

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<author><name sortKey="Shoaibi, Azadeh" sort="Shoaibi, Azadeh" uniqKey="Shoaibi A" first="Azadeh" last="Shoaibi">Azadeh Shoaibi</name>
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<series><title level="j" type="main">The Annals of pharmacotherapy</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anticoagulant</term>
<term>Antiviral</term>
<term>Concurrent</term>
<term>Drug interaction</term>
<term>Health insurance</term>
<term>Hemorrhage</term>
<term>Human</term>
<term>Influenza</term>
<term>Oseltamivir</term>
<term>Warfarin</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Hémorragie</term>
<term>Simultané</term>
<term>Warfarine</term>
<term>Oséltamivir</term>
<term>Assurance maladie</term>
<term>Interaction médicamenteuse</term>
<term>Grippe</term>
<term>Homme</term>
<term>Anticoagulant</term>
<term>Antiviral</term>
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<front><div type="abstract" xml:lang="en">Background: During the 2009 HINI influenza pandemic, the UK Medicines and Healthcare Products Regulatory Agency received case reports suggesting a potentiation of warfarin anticoagulation by the antiviral drug oseltamivir. We evaluated this putative interaction using Medicare data. Objective: To determine the frequency of bleeding following addition of oseltamivir or comparator drugs among Medicare beneficiaries taking warfarin. Methods: This was a retrospective cohort evaluation using Medicare nationwide data. Cohort members were Medicare Parts A, B, and D beneficiaries from June 30, 2006 to October 31, 2010 receiving warfarin for at least I month prior to a concomitant drug of interest (oseltamivir, ampicillin, trimethoprim-sulfamethoxazole (TMP-SMX), and angiotensin-converting enzyme (ACE) inhibitors). Bleeding within 14 days of new prescriptions for oseltamivir or comparators was identified using inpatient or emergency department ICD-9 (International Classification of Diseases, ninth revision) discharge diagnosis codes for gastrointestinal hemorrhage, epistaxis, hematuria, and intracranial bleeding. Patients with bleeding within 30 days preceding the prescription concomitant to warfarin were excluded. Results: With concomitant ACE inhibitors as reference, adjusted odds ratios (ORs) for any bleeding events within 14 days were 1.47 (95% confidence interval [Cl] = 1.08-1.88), 1.24 (95% Cl = 0.97-1.57), and 2.74 (95% Cl = 2.53-3.03), for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. In a sensitivity analysis, adjusted ORs over a 7-day period were 1.89 (95% Cl = 1.29-2.59), 1.47 (95% Cl = 1.06-2.02), and 3.07 (95% Cl = 2.76-3.49) for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. Conclusions: Bleeding with oseltamivir plus warfarin was not significantly increased over a 14-day observation period; a sensitivity analysis showed a statistically significant increase over a 7-day period; in contrast, the data consistently showed the known tendency of TMP-SMX to potentiate the effects of warfarin. The results should be interpreted with the limitations of this approach in mind, including the inability to control for unmeasured confounders.</div>
</front>
</TEI>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Californie</li>
<li>Maryland</li>
</region>
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<tree><country name="États-Unis"><region name="Maryland"><name sortKey="Mosholder, Andrew D" sort="Mosholder, Andrew D" uniqKey="Mosholder A" first="Andrew D." last="Mosholder">Andrew D. Mosholder</name>
</region>
<name sortKey="Kelman, Jeffrey A" sort="Kelman, Jeffrey A" uniqKey="Kelman J" first="Jeffrey A." last="Kelman">Jeffrey A. Kelman</name>
<name sortKey="Macurdy, Thomas E" sort="Macurdy, Thomas E" uniqKey="Macurdy T" first="Thomas E." last="Macurdy">Thomas E. Macurdy</name>
<name sortKey="Macurdy, Thomas E" sort="Macurdy, Thomas E" uniqKey="Macurdy T" first="Thomas E." last="Macurdy">Thomas E. Macurdy</name>
<name sortKey="Racoosin, Judith A" sort="Racoosin, Judith A" uniqKey="Racoosin J" first="Judith A." last="Racoosin">Judith A. Racoosin</name>
<name sortKey="Shoaibi, Azadeh" sort="Shoaibi, Azadeh" uniqKey="Shoaibi A" first="Azadeh" last="Shoaibi">Azadeh Shoaibi</name>
<name sortKey="Wernecke, Michael" sort="Wernecke, Michael" uniqKey="Wernecke M" first="Michael" last="Wernecke">Michael Wernecke</name>
<name sortKey="Worrall, Christopher" sort="Worrall, Christopher" uniqKey="Worrall C" first="Christopher" last="Worrall">Christopher Worrall</name>
<name sortKey="Young, Stephanie" sort="Young, Stephanie" uniqKey="Young S" first="Stephanie" last="Young">Stephanie Young</name>
</country>
</tree>
</affiliations>
</record>

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Bleeding Events Following Concurrent Use of Warfarin and Oseltamivir by Medicare Beneficiaries

Bleeding Events Following Concurrent Use of Warfarin and Oseltamivir by Medicare Beneficiaries

Source :

Descripteurs français

English descriptors

Abstract

Links toward previous steps (curation, corpus...)

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri