The nature and frequency of potential warfarin drug interactions that increase the risk of bleeding in patients with atrial fibrillation

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Abstract
Purpose To determine the frequency with which atrial fibrillation (AF) patients receiving warfarin are prescribed interacting drugs that could increase bleeding risks. Methods We retrospectively examined medical records for 704 Medicare beneficiaries ≥65 years of age discharged from Kansas hospitals with AF. We identified all patients receiving warfarin and examined discharge prescriptions for drugs that could increase bleeding risk either by increasing the international normalized ratio (INR) or directly inhibiting hemostasis. Results Of 256 patients discharged on warfarin, 138 (54%) were prescribed another medication that could increase bleeding risk. Among these patients, 106 (41%) were discharged with a total of 150 prescriptions for drugs that could interact with warfarin to increase the INR. Antibiotics accounted for 67% of these prescriptions. Fifty‐three patients (21%) received 56 prescriptions for drugs which could inhibit hemostasis. These were primarily antiplatelet drugs with 61% of the prescriptions for aspirin. Patients with coronary artery disease were more likely than others to be prescribed warfarin plus antiplatelet agents (OR=2.80; p=0.04). More than one interacting drug was prescribed for 20% of the patients. Conclusions AF patients discharged on warfarin were frequently prescribed concomitant medications that increase bleeding risks. These patients should be closely monitored and counseled to watch for signs of bleeding. Copyright © 2002 John Wiley & Sons, Ltd.