Effects of Fluoroquinolones on Aortic Aneurysm or Dissection Processes: A Systematic Review and Meta-Analysis

This systematic review/meta-analysis investigated the risks of fluoroquinolones (FQs) for aortic aneurysms (thoracic/abdominal) and Stanford A/B dissections.

We searched EMBASE, Ovid, PubMed, Web of Science, and Scopus databases in February 2024. Eligible observational studies were those that presented adjusted risk estimates for aortic aneurysm or dissection (AAD) incidence, aortic-specific mortality, or all-cause mortality in FQ-treated versus untreated unexposed populations.

A total of 13 studies were included (36,224,419 participants), eight of which were cohort studies, two were nested case-control studies, and three were case-crossover designs. FQ exposure was associated with significantly elevated de novo AAD risk within 30 days (relative risk (RR) = 3.40, 95% confidence interval (CI) = [2.72, 4.24]; heterogeneity: I ² = 41.5%, p = 0.11) and 60 days (RR = 3.53, 95% CI = [2.78, 4.49]; heterogeneity: I ² = 87.0%, p < 0.0001). The analysis also revealed a higher all-cause mortality risk for FQs versus non-exposed controls (odds ratio (OR) = 1.44, 95% CI = [1.08, 1.93]; heterogeneity: I ² = 0%, p = 0.80). Subgroup analysis demonstrated comparable aortic dissection (AD) and aortic aneurysm (AA) risks, except for a significantly increased de novo AA risk at 30 days (RR = 9.13, 95% CI = [6.05, 13.78]; heterogeneity: I ² = 68.7%, p = 0.07) and 60 days (OR = 1.69, 95% CI = [1.27, 2.26]; heterogeneity: I ² = 52%, p = 0.10).

This meta-analysis found a significant association between FQ use and short-term AAD risk. These results suggest that clinicians should weigh the risks of AAD before prescribing FQs, especially in patients with aortic vulnerability or pre-existing aortic pathology, considering alternative treatments when feasible.

CRD42024509853 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024509853).