Document Detail

Warfarin monitoring in ambulatory older individuals receiving antimicrobial therapy.
MedLine Citation:
PMID:  16207095     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To determine the frequency of monitoring of international normalized ratio (INR) within 14 days of coprescription of warfarin and antimicrobial therapy and to evaluate differences in INR monitoring among antimicrobials. DESIGN: Retrospective cohort study. SETTING: Group model health maintenance organization. SUBJECTS: Patients aged 65 years or older who were taking warfarin and an antimicrobial agent. MEASUREMENTS AND MAIN RESULTS: Patients who received dispensings of both warfarin and an antimicrobial agent were identified. We found 2959 coprescribing instances in 1816 patients. The INR values were obtained for 2267 (77%) coprescribing situations within 14 days. Monitoring occurred more frequently (p<0.001) when warfarin was coprescribed with fluoroquinolones (641 [85%] of 755 situations), metronidazole (59 [81%] of 73), tetracyclines (274 [80%] of 341), or macrolides (201 [83%] of 243) than when warfarin was coprescribed with sulfonamides (35 [66%] of 53), penicillins (604 [71%] of 856), or cephalosporins (419 [71%] of 591). Among monitored patients, a higher proportion of monitoring (p<0.001) occurred within 7 days for patients prescribed antifungals (87%), fluoroquinolones (88%), tetracyclines (82%), metronidazole (86%), sulfonamides (86%), or macrolides (85%) than for patients prescribed cephalosporins (68%) or penicillins (75%). CONCLUSION: Most older patients coprescribed warfarin and an antimicrobial in our organization had INR monitoring within 7 days. This is consistent with appropriate practice to manage a risk of clinically important drug-drug interaction between an antimicrobial agent and warfarin. Prospective identification of patients requiring INR monitoring after coprescription of interacting drugs by using merged administrative pharmacy and laboratory data should be further evaluated as a tool to improve clinical outcomes.
Marsha A Raebel; Daniel M Witt; Nikki M Carroll; David J Magid
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pharmacotherapy     Volume:  25     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-10-06     Completed Date:  2005-10-26     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1055-61     Citation Subset:  IM    
Clinical Research Unit, Kaiser Permanente of Colorado, and the School of Pharmacy, University of Colorado, Denver, Colorado 80237-8066, USA.
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MeSH Terms
Ambulatory Care / statistics & numerical data*
Anti-Infective Agents / therapeutic use*
Anticoagulants / blood,  therapeutic use*
Cohort Studies
Drug Interactions
Drug Prescriptions
International Normalized Ratio*
Monitoring, Physiologic
Quality of Health Care
Retrospective Studies
Warfarin / blood,  therapeutic use*
Reg. No./Substance:
0/Anti-Infective Agents; 0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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