Skip to content
Research Article Open access CC BY 4.0

Drug-drug Interactions between Warfarin and Antimicrobials: A Systematic Review

Ali Hadi Al Sulayi, Abdulmanem Alawi Almassabi, Saeed Saleh Mohammed Al-Mansour, Hassan Saeed Hassan Al Mansour, Mohammed Hamad Mohammed Al Kulib, Mohammed Mana Masoud Al Aqil, Ali Hamad Al Masad, Yahya Salem Al Abbas

Asian Journal of Medicine and Health · pp. 157–164 · Published 16 Dec 2022

10.9734/ajmah/2022/v20i12778

Abstract

Introduction: Warfarin is a highly effective oral anticoagulant; however, its use is confined due to a valid concern about bleeding. This systematic review investigates the drug-drug interactions that may occur in patients on warfarin therapy and the use of antimicrobials. Methodology: PubMed, Web of Science, Science Direct, EBSCO, and Cochrane library were searched. Study articles were screened by title and abstract using Rayyan QCRI then a full-text assessment was conducted. Results: Eleven studies were included, with a total of 83438 patients. The included studies have reported different antibiotics were associated with bleeding events in patients on warfarin therapy. Three studies associated reported GIT bleeding. Older adults and patients who underwent valve replacement surgery and were on warfarin therapy were found to have an increase in INR with associated antibiotic use. Conclusion: Patients on warfarin run the risk of a variety of drug interactions. Most interactions but not all—increase the risk of bleeding, and the majority of these are linked to higher international normalised ratios. The good news for doctors is that most common drug interactions with warfarin are triggered by a small number of well-known drug classes, and their effects are shown through a small number of pathways, many of which are clear. The risk of harm brought on by drug interactions can be decreased by being aware of these guidelines, using thoughtful prescription practises, and exercising judicious monitoring when new medications are added to regimens containing warfarin.

Warfarin antimicrobials drug interaction bleeding systematic review

References (24)

  1. 1 Rayyan—a web and mobile app for systematic reviews [DOI]
  2. 2 Burden of valvular heart diseases: a population-based study [DOI]
  3. 3 Systematic Overview of Warfarin and Its Drug and Food Interactions [DOI]
  4. 4 Optimal Oral Anticoagulant Therapy in Patients with Mechanical Heart Valves [DOI]
  5. 5 American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism [DOI]
  6. 6 Pros and cons of new oral anticoagulants [DOI]
  7. 7 Frequency of adverse events in patients with poor anticoagulation: a meta-analysis [DOI]
  8. 8 Warfarin Pharmacology, Clinical Management, and Evaluation of Hemorrhagic Risk for the Elderly [DOI]
  9. 9 Trends in utilization of warfarin and direct oral anticoagulants in older adult patients with atrial fibrillation [DOI]
  10. 10 Direct oral anticoagulants versus warfarin: is new always better than the old? [DOI]
  11. 11 The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K.
  12. 12 Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults [DOI]
  13. 13 Warfarin With Fluoroquinolones, Sulfonamides, or Azole Antifungals: Interactions and the Risk of Hospitalization for Gastrointestinal Bleeding [DOI]
  14. 14 Drug interactions with warfarin: what clinicians need to know [DOI]
  15. 15 Serious Bleeding Events due to Warfarin and Antibiotic Co-prescription in a Cohort of Veterans [DOI]
  16. 16 Warfarin Interactions With Antibiotics in the Ambulatory Care Setting [DOI]
  17. 17 Major bleeding risk associated with warfarin and co‐medications in the elderly population [DOI]
  18. 18 Warfarin–Antibiotic Interactions in Older Adults of an Outpatient Anticoagulation Clinic [DOI]
  19. 19 Administrative Claims Analysis of the Relationship Between Warfarin Use and Risk of Hemorrhage Including Drug-Drug and Drug-Disease Interactions [DOI]
  20. 20 Main comedications associated with major bleeding during anticoagulant therapy with coumarins [DOI]
  21. 21 Effect of Ciprofloxacin on the Pharmacokinetics and Pharmacodynamics of Warfarin [DOI]
  22. 22 The safety of levofloxacin in elderly patients on warfarin [DOI]
  23. 23 Effect of Quinolones Versus Cefixime on International Normalized Ratio Levels After Valve Replacement Surgery with Warfarin Therapy [DOI]
  24. 24 European Journal of Clinical Pharmacology [DOI]

Cited by 0

No indexed citations yet.

Related research

Article metrics

Real usage data collected on this platform.

64

Page views

0

PDF downloads

28

Outbound clicks

0

Citations

Views over time

Views by country

Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".

Traffic sources

Referring site, by host.

Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.