Evidence map›Paper›PMID 22847619›Full record

ArticleEuropean journal of clinical pharmacology2013

Concurrent use of tramadol and oral vitamin K antagonists and the risk of excessive anticoagulation: a register-based nested case-control study.

Anton Pottegård, Peter M Meegaard, Line H V Holck, Rene dePont Christensen, Hanne Madsen, Jesper Hallas

Abstract read
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In one paragraph

Article in European journal of clinical pharmacology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Observational
  5. Bleeding and Elevated INR Secondary to Concomitant Tramadol and Warfarin Administration.P & T : a peer-reviewed journal for formulary management · 2019
    Article
  6. Article
  7. Observational
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Anton PottegårdInstitute of Public Health, Clinical Pharmacology, University of Southern Denmark, Odense, Denmark. apottegaard@health.sdu.dk
Peter M Meegaard
Line H V Holck
Rene dePont Christensen
Hanne Madsen
Jesper Hallas

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe objective was to assess whether the concurrent use of tramadol and vitamin K antagonists (VKAs) leads to an increased risk of excessive anticoagulation.

designThe study was designed as a case-control study, nested within users of VKA and with tramadol use as our main exposure. We used conditional logistic regression to control for potential confounders.

settingPrescription data from primary care were obtained from Odense Pharmacoepidemiological Database (OPED). Information about hospital admissions was obtained from the patient administrative system of Funen County (FPAS). SUBJECTS: Both cases and controls were selected from users of VKA. Cases were defined by being hospitalised with a main diagnosis indicating excessive anticoagulation. For each case, we selected 15 controls among VKA users, matched by age and sex.

main outcome measureOdds ratio for experiencing excessive anticoagulation attributable to the use of tramadol.

resultsA total of 178 patients were included, 30 of which were exposed to tramadol, along with 2643 controls, 114 of which were exposed to tramadol. The adjusted odds-ratio for experiencing excessive anticoagulation during use of tramadol was 3.1 (1.9-5.2). This corresponds to, on average, one excess case per 250 treatment years (CI 125-584). The result is potentially confounded by concomitant paracetamol use and the presence of acute illness.

conclusionCaution is advised when using tramadol in patients using VKA, and if possible, an alternative pain-medication should be used.

Indexed as

Administration, OralAgedAged, 80 and overAnalgesics, OpioidAnticoagulantsBlood CoagulationCase-Control StudiesConfounding Factors, EpidemiologicDenmarkDrug InteractionsDrug PrescriptionsFemaleHemorrhageHumansLogistic ModelsMaleAnalgesics, OpioidAnticoagulantsTramadolVitamin K

Identifiers

PMID22847619

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.