Fluoroquinolones and the risk of aortopathy: A systematic review and meta-analysis

Introduction: Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection. Objective: We performed a meta-analysis with a comprehensive literature review to further investigate this association. Methods: This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) exposed to fluoroquinolones or control antibiotics (amoxicillin/any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Heterogeneity was calculated using Q statistic I². Results: A total of 6 studies—comprised of 59% males—were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62-2.75; I² = 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02-3.95, I² = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23-3.06; I² = 71.33) also were significantly increased. Conclusion: Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined.