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Prevalence of Drug Combinations Increasing Bleeding Risk Among Warfarin Users With and Without Alzheimer’s Disease

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Abstract

Purpose

The aim of this study was to analyse the prevalence and predictors of drug combinations increasing bleeding risk among warfarin users with and without Alzheimer’s disease (AD).

Methods

This retrospective observational study utilised data from the Finnish MEDALZ-2005 cohort. The MEDALZ-2005 study included all community-dwelling persons with a clinically verified diagnosis of AD at the end of 2005, and one comparison person without AD for each case. Data on drug use was collected from the Prescription Register. We included persons who were warfarin users during the study period 2006–2009. Drug combinations increasing bleeding risk with warfarin included selective serotonin reuptake inhibitors (SSRIs), non-steroidal anti-inflammatory agents (NSAIDs), other antithrombotic drugs and tramadol. Factors associated with combination use were investigated with logistic regression.

Results

During the follow-up, 3385 persons with AD and 4830 persons without AD used warfarin. Drug combinations increasing bleeding risk were more common in warfarin users with AD than without AD [35.9 and 30.5 %, respectively (p < 0.0001)]. The most common combination was SSRIs and warfarin, which was more common among persons with AD (23.8 %) than among persons without AD (10.9 %). NSAIDs and warfarin combination was more common among persons without AD. Combination use was associated with AD, female gender, younger age, diabetes mellitus, rheumatoid arthritis and asthma/chronic obstructive pulmonary disease (COPD).

Conclusions

Use of drug combinations increasing bleeding risk was more common among warfarin users with AD. Special attention should be paid to minimise the duration of concomitant use and to find safer alternatives without increased bleeding risk.

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Acknowledgments

The authors thank the maintainers of Finnish healthcare registers for enabling this research.

Author information

Authors and Affiliations

  1. Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland

    Heidi Taipale, Hanna Vuorikari, Marjaana Koponen & Sirpa Hartikainen

  2. School of Pharmacy, University of Eastern Finland, Kuopio, Finland

    Heidi Taipale, Hanna Vuorikari, Marjaana Koponen & Sirpa Hartikainen

  3. Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland

    Heidi Taipale

  4. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Antti Tanskanen & Jari Tiihonen

  5. National Institute for Health and Welfare, Helsinki, Finland

    Antti Tanskanen

  6. Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland

    Jari Tiihonen

  7. School of Medicine, University of Eastern Finland, Kuopio, Finland

    Raimo Kettunen

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  1. Heidi Taipale
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Corresponding author

Correspondence to Heidi Taipale.

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Funding

None to declare.

Conflicts of interest

JT has served as a consultant to Lundbeck, Organon, Janssen-Cilag, Eli Lilly, AstraZeneca, F. Hoffman-La Roche and Bristol-Myers Squibb. He has received fees for giving expert opinions to Bristol-Myers Squibb and GlaxoSmithKline, lecture fees from Janssen-Cilag, Bristol-Myers Squibb, Eli Lilly, Pfizer, Lundbeck, GlaxoSmithKline, AstraZeneca and Novartis; and a grant from the Stanley Foundation. JT is a member of advisory boards for AstraZeneca, Janssen-Cilag and Otsuka. Other authors declare no conflicts of interest.

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Taipale, H., Vuorikari, H., Tanskanen, A. et al. Prevalence of Drug Combinations Increasing Bleeding Risk Among Warfarin Users With and Without Alzheimer’s Disease. Drugs Aging 32, 937–945 (2015). https://doi.org/10.1007/s40266-015-0316-3

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