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Ciprofloxacin-warfarin coagulopathy: a case series
R J Ellis1, M S Mayo, D M Bodensteiner
1Division of Hematology/Oncology, University of Kansas Medical Center, Kansas City, Kansas 66160-7233, USA. rellis2@kumc.edu
American Journal of Hematology
|December 22, 1999
Summary
Ciprofloxacin can increase warfarin
Area of Science:
- Pharmacology
- Drug Interactions
- Clinical Medicine
Background:
- Warfarin is a common anticoagulant.
- Ciprofloxacin is a broad-spectrum antibiotic.
- Drug interactions between ciprofloxacin and warfarin can lead to serious bleeding.
Observation:
- A review of 66 cases reported to the FDA's Spontaneous Reporting System (SRS) database from 1987-1997.
- The median age of affected patients was 72 years.
- Patients often required multiple medications (polypharmacy).
Findings:
- Ciprofloxacin can cause exaggerated hypoprothrombinemic response and bleeding in warfarin-treated patients.
- Bleeding occurred in 25 cases, with 15 hospitalizations and one death.
- Active treatment of coagulopathy led to faster resolution than observation.
Implications:
- The ciprofloxacin-warfarin interaction is most common in elderly patients on polypharmacy.
- Clinicians must be aware of this potential drug-drug interaction.
- Prompt recognition and treatment of coagulopathy are crucial to prevent severe bleeding complications.