Fibrate Warfarin and Statin Warfarin Coadministration and Hospitalization 2.18.09

Fibrate-Warfarin and Statin-Warfarin Coadministration and Hospitalization for Gastrointestinal Bleeding Hedi Schelleman *, Warren B. Bilker*, Colleen M. Brensinger*, Fei Wan*, Yu-Xiao Yang*, Sean Hennessy* * University of Pennsylvania School of Medicine ,[object Object],[object Object],[object Object],[object Object],[object Object],BACKGROUND Table 2: Association between initiation of precipitant drugs (exposed versus unexposed) and hospitalization for gastrointestinal bleeding in patients receiving warfarin in case-control study Table 1. Baseline characteristics Figure 1: Association between initiation of precipitant drug (exposed versus unexposed) and hospitalization for gastrointestinal bleeding in chronic warfarin users Each diamond represents the OR of interest and the vertical line the 95% CI. All analyses are adjusted for age, gender, race, state, prior GI bleed, diabetes, and the number of prior warfarin prescriptions filled on the index date 1 to 30 days prior 31 to 60 days prior 61 to 120 days prior to the index date to the index date to the index date 1 to 30 days prior 31 to 60 days prior 61 to 120 days prior to the index date to the index date to the index date 1 to 30 days prior 31 to 60 days prior 61 to 120 days prior to the index date to the index date to the index date 1 to 30 days prior 31 to 60 days prior 61 to 120 days prior to the index date to the index date to the index date 1 to 30 days prior 31 to 60 days prior 61 to 120 days prior to the index date to the index date to the index date 1 to 30 days prior 31 to 60 days prior 61 to 120 days prior to the index date to the index date to the index date No data No data No data Funding: NIH grant R01AG02152 and CTSA grant 5KL2RR024132 ,[object Object],[object Object],OBJECTIVE Variable Cases (N=12,193) Controls (N=609,650) Unadjusted ORs and 95% CI Fenofibrate* 39 (0.32%) 2,117 (0.35%) 0.92 (0.67-1.27) Gemfibrozil* 67 (0.55%) 3,010 (0.49%) 1.11 (0.87-1.42) Fluvastatin* 16 (0.13%) 1,834 (0.30%) 0.44 (0.27-0.71) Simvastatin * 277 (2.27%) 14,909 (2.45%) 0.93 (0.82-1.05) Atorvastatin* 499 (4.09%) 32,089 (5.26%) 0.77 (0.70-0.84) Pravastatin * 113 (0.93%) 8,652 (1.42%) 0.65 (0.54-0.78) Male 3,950 (32.40%) 203,916 (33.45%) 0.95 (0.92-0.99) Race African-American Caucasian Other 1,904 (15.62%) 7,690 (63.07%) 2,599 (21.32%) 81,290 (13.33%) 393,017 (64.47%) 135,343 (22.20%) Reference 0.84 (0.79-0.88) 0.82 (0.77-0.87) Age <50 years 50-59 years 60-69 years 70-79 years 80+ years 958 (7.86%) 1,123 (9.21%) 1,984 (16.27%) 3,502 (28.72%) 4,626 (37.94%) 90,597 (14.86%) 74,015 (12.14%) 103,406 (16.96%) 154,803 (25.39%) 186,829 (30.65%) Reference 1.43 (1.32-1.56) 1.81 (1.68-1.96) 2.14 (1.99-2.30) 2.34 (2.18-2.51) Prior GI bleed ‡ 4,165 (34.16%) 86,970 (14.27%) 3.12 (3.00-3.24) Diabetes † 6,445 (52.86%) 249,325 (40.90%) 1.62 (1.56-1.68) Number of prior warfarin prescriptions filled on the index date 7 (IQR: 2-19) 11 (IQR: 4-23) 0.99 (0.988-0.991) IQR = Interquartile range * Currently exposed, defined as a prescription in the 30 days prior to the index date † Ever in the past ‡ Either a outpatient diagnosis for GI bleed or an inpatient diagnosis prior to initiation of warfarin 1 to 30 days OR (95% CI) 31 to 60 days OR (95% CI) 61 to 120 days OR (95% CI) Model Minimally adjusted * Fully adjusted † Minimally adjusted * Fully adjusted † Minimally adjusted * Fully adjusted † Fenofibrate No data ‡ No data ‡ 2.14 (0.95-4.84) 2.07 (0.91-4.69) 1.42 (0.67-3.02) 1.31 (0.62-2.79) Gemfibrozil 2.12 (1.29-3.50) 1.96 (1.19-3.24) 1.48 (0.66-3.33) 1.37 (0.61-3.10) 1.29 (0.64-2.59) 1.23 (0.61-2.48) Fluvastatin 1.49 (0.70-3.15) 1.45 (0.68-3.09) No data ‡ No data ‡ No data ‡ No data ‡ Simvastatin 1.47 (1.10-1.96) 1.33 (1.00-1.78) 1.35 (0.91-2.01) 1.26 (0.85-1.88) 1.16 (0.83-1.61) 1.10 (0.79-1.53) Atorvastatin 1.43 (1.15-1.78) 1.29 (1.04-1.61) 0.98 (0.70-1.39) 0.96 (0.68-1.35) 0.66 (0.49-0.90) 0.62 (0.46-0.85) Pravastatin 0.71 (0.41-1.22) 0.66 (0.38-1.14) 0.91 (0.47-1.75) 0.88 (0.45-1.71) 0.55 (0.29-1.02) 0.54 (0.29-1.01) * Adjusted for age, gender, race, and state † Adjusted for age, gender, race, state, prior GI bleed, diabetes, and number of warfarin prescriptions filled by the index date ‡ Insufficient number of exposed cases to analyze RESULTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],METHODS ,[object Object],[object Object],[object Object],[object Object],CONCLUSIONS

Fibrate Warfarin and Statin Warfarin Coadministration and Hospitalization 2.18.09

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Fibrate Warfarin and Statin Warfarin Coadministration and Hospitalization 2.18.09