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J Am Coll Cardiol. 2018 Sep 18;72(12):1369-1378. doi: 10.1016/j.jacc.2018.06.067.

Oral Fluoroquinolone and the Risk of Aortic Dissection.

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Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
Dipartimento di Scienze Biomediche e Cliniche, Ospedale "L. Sacco," Università degli Studi di Milano, Milan, Italy.
Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan.
Department of Family Medicine, Taipei Medical University Hospital and School of Medicine, Taipei Medical University, Taipei, Taiwan.



Previous studies raised safety concerns on the association between fluoroquinolone treatment and serious collagen disorders, aortic aneurysm and dissection (AA/AD).


This study sought to evaluate this association via a case-crossover analysis in a large national administrative database.


A case-crossover design was used to compare the distributions of fluoroquinolone exposure for the same patient across a 60-day period before the AA/AD event (hazard period) and 1 randomly selected 60-day period (referent period) between 60 to 180 days before the AA/AD events. In the sensitivity analysis, the authors repeated the main analysis using a 1:5 ratio of hazard period to referent period, to adjust for the effect of time-variant confounders. A disease-risk score-matched time control analysis was performed to investigate the potential time-trend bias. The risks were calculated by a conditional logistic regression model.


A total of 1,213 hospitalized AA/AD patients were identified between 2001 and 2011. In the main case-crossover analysis, exposure to fluoroquinolone was more frequent during the hazard periods than during the referent periods (1.6% vs. 0.6%; odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.14 to 6.46). In the sensitivity analysis, after adjustment for infections and co-medications, the risk remains significant (OR: 2.05; 95% CI: 1.13 to 3.71). An increased risk of AA/AD was observed for prolonged exposure to fluoroquinolones (OR: 2.41 for 3- to 14-day exposure; OR: 2.83 for >14-day exposure). Susceptible period analysis revealed that the use of fluoroquinolone within 60 days was associated with the highest risk of AA/AD. In the case-time-control analysis, there was no evidence that the observed association is due to temporal changes in fluoroquinolone exposure.


Exposure to fluoroquinolone was substantially associated with AA/AD. This risk was modified by the duration of fluoroquinolone use and the length of the hazard period.


aortic and arterial diseases; aortic aneurysm; aortic dissection; fluoroquinolones


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