title: The nature and frequency of potential warfarin drug interactions that increase the risk of bleeding in patients with atrial fibrillation.
abstract: OBJECTIVE
  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 > or = 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.
authors.affiliation: Departments of Pharmacy Practice and Cardiovascular Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7231, USA. phoward@kumc.edu
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Howard
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Engelman
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Patterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004347:Drug Interactions; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin