Adherence to guidelines for avoiding drug interactions associated with warfarin--a Nationwide Swedish Register Study

To investigate the extent to which clinicians avoid well-established drug-drug interactions associated with warfarin. We hypothesised that clinicians would avoid combining non-steroidal anti-inflammatory drugs (NSAIDs), tramadol and sulfamethoxazole with warfarin. A cross-sectional analysis of natio...

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Bibliographic Details
Published in:PloS one 2014-05, Vol.9 (5), p.e97388
Main Authors: Lindh, Jonatan D, Andersson, Marine L, Mannheimer, Buster
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analgesics
Anti-inflammatory agents
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage
Antibiotics
Anticoagulants
Automation
Ciprofloxacin
Codeine
Cross-Sectional Studies
Dispensing
Drug Interactions
Drugs
Family physicians
Guideline Adherence
Humans
Inflammation
Laboratories
Medical personnel
Medicin och hälsovetenskap
Medicine and Health Sciences
Middle Aged
Nonsteroidal anti-inflammatory drugs
Odds Ratio
Older people
Patients
Pharmaceuticals
Physicians
Prescription drugs
Registries
Retrospective Studies
Steroidal anti-inflammatory agents
Substance abuse treatment
Sulfamethoxazole
Sulfamethoxazole - administration & dosage
Sweden
Tramadol
Tramadol - administration & dosage
Warfarin
Warfarin - administration & dosage
Warfarin - adverse effects
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Summary:To investigate the extent to which clinicians avoid well-established drug-drug interactions associated with warfarin. We hypothesised that clinicians would avoid combining non-steroidal anti-inflammatory drugs (NSAIDs), tramadol and sulfamethoxazole with warfarin. A cross-sectional analysis of nationwide dispensing data was performed in Swedish individuals 18 years or older (n =  7,563,649). Odds ratios of interacting NSAIDs, tramadol and sulfamethoxazole versus respective prevalence of comparator drugs codeine, and ciprofloxacin in patients co-dispensed interacting warfarin versus patients unexposed was calculated. The odds of receiving an interacting NSAID versus the comparator codeine was markedly lower in patients with warfarin than in the remaining population (adjusted OR 0.21; 95% CI 0.20 - 0.22). Also, the interacting drugs tramadol and sulfamethoxazole were less common among patients dispensed warfarin as compared to the remaining population, although the decrease was much more modest (adjusted OR 0.83; CI 0.80-0.87 and 0.81; CI 0.73 - 0.90). In conclusion, Swedish doctors in the vast majority of cases refrain from prescribing NSAIDs to patients already on warfarin. Tramadol and sulfamethoxazole are however rarely avoided.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0097388