Journal of Korean Medical Science · 2010 · 40 citations · 16 references
PharmacyPharmacologyPharmacotherapyClinical PharmacologyDrug InteractionsPharmacovigilanceAdverse Drug Event DetectionAdverse Drug Event PreventionAnticoagulation ManagementDrug-drug Interaction RiskInteraction Risk AssessmentPharmacoepidemiologyAnticoagulation-related Bleeding RiskBleedingBleeding Risk InteractionsDrug Interactions In AnticoagulationDrug-drug Interaction EvaluationNonsteroidal Anti-inflammatory Drug SafetyNonsteroidal Anti-inflammatory Drug-associated BleedingSurrogate Endpoints
Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with the oral anticoagulant warfarin and can cause a serious bleeding complication. In this study, we evaluated the risk factors for international normalized ratio (INR) increase, which is a surrogate marker of bleeding, after addition of an NSAID in a total of 98 patients who used warfarin. Patient age, sex, body mass index, maintenance warfarin dose, baseline INR, coadministered medications, underlying diseases, and liver and kidney functions were evaluated for possible risk factors with INR increase > or =15.0% as the primary end-point. Of the 98 patients, 39 (39.8%) showed an INR elevation of > or =15.0% after adding a NSAID to warfarin therapy. Multivariate analysis showed that high maintenance dose (>40 mg/week) of warfarin (P=0.001), the presence of coadministered medications (P=0.024), the use of meloxicam (P=0.025) and low baseline INR value (P=0.03) were the risk factors for INR increase in respect to NSAID-warfarin interaction. In conclusion, special caution is required when an NSAID is administered to warfarin users if patients are taking warfarin >40 mg/week and other medications interacting with warfarin.
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Effect of <i>VKORC1</i> Haplotypes on Transcriptional Regulation and Warfarin Dose
Mark J. Rieder, Alex P. Reiner, Brian F. Gage et al. · New England Journal of Medicine · 2005 · 1.4K citations · Full text