ArticleJAMA internal medicine2020
Risk of Hospitalization With Hemorrhage Among Older Adults Taking Clarithromycin vs Azithromycin and Direct Oral Anticoagulants.
Article in JAMA internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
What it found
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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.
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.
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Who cites it
28 citing papers in PubMed, 55 citations in OpenAlex.
- Effect of Clarithromycin, a Strong CYP3A and P-glycoprotein Inhibitor, on the Pharmacokinetics of Edoxaban in Healthy Volunteers and the Evaluation of the Drug Interaction with Other Oral Factor Xa Inhibitors by a Microdose Cocktail Approach.Cardiovascular drugs and therapy · 2024Trial
- Gastrointestinal safety of oral erythromycin, clarithromycin, and azithromycin in pediatric patients: a FAERS pharmacovigilance study.Pediatric research · 2026Article
- Regional disparities in the care and outcomes of atrial fibrillation patients in a universal health care system: a population-based cohort study.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Article
- Adverse events with co-prescription of angiotensin receptor blockers and clarithromycin compared to azithromycin: A population-based retrospective cohort study.Pharmacotherapy · 2025Article
- Apixaban vs rivaroxaban in patients with atrial fibrillation at high or low bleeding risk: A population-based cohort study.Heart rhythm · 2025Article
- Association of polypharmacy with clinical outcomes and healthcare utilization in older adults with cardiometabolic diseases: a retrospective cohort study.International journal of clinical pharmacy · 2025Article
- Clinical Challenges in Treating Cancer-Associated Thrombosis: A Clinically Oriented Review.Acta haematologica · 2025Review
- Effect of drug interactions with apixaban on clinical outcomes in cancer patients with venous thromboembolism.Frontiers in oncology · 2025Article
- Proper application of anticoagulation therapy on cancer-associated venous thrombosis.Blood research · 2024Review
- Antibiotic-Drug Interactions in the Intensive Care Unit: A Literature Review.Antibiotics (Basel, Switzerland) · 2024Review
- Management of direct oral anticoagulant drug interactions in hospitalized patients.Journal of thrombosis and thrombolysis · 2024Article
- Rivaroxaban Plasma Concentration and Clinical Outcomes on Older Patients with Non-valvular Atrial Fibrillation and Pulmonary Infection.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2024Observational
- Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation.BMC cardiovascular disorders · 2023Article
- Association between concurrent use of diltiazem and DOACs and risk of bleeding in atrial fibrillation patients.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023Article
- Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics.British journal of clinical pharmacology · 2023Article
- DOAC drug interactions management resource.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC · 2022Article
- Individual Pharmacotherapy Management (IPM)-IV: Optimized Usage of Approved Antimicrobials Addressing Under-Recognized Adverse Drug Reactions and Drug-Drug Interactions in Polypharmacy.Antibiotics (Basel, Switzerland) · 2022Article
- Complexity and clinical significance of drug-drug interactions (DDIs) in oncology: challenging issues in the care of patients regarding cancer-associated thrombosis (CAT).Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Review
- Drug Interactions Affecting Oral Anticoagulant Use.Circulation. Arrhythmia and electrophysiology · 2022Review
- Challenging issues in the management of cancer-associated venous thromboembolism.Blood research · 2022Review
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Clarithromycin is a commonly prescribed antibiotic associated with higher levels of direct oral anticoagulants (DOACs) in the blood, with the potential to increase the risk of hemorrhage. Objective: To assess the 30-day risk of a hospital admission with hemorrhage after coprescription of clarithromycin compared with azithromycin among older adults taking a DOAC. Design, Setting, and Participants: This population-based, retrospective cohort study was conducted among adults of advanced age (mean [SD] age, 77.6 [7.2] years) who were newly coprescribed clarithromycin (n = 6592) vs azithromycin (n = 18 351) while taking a DOAC (dabigatran, apixaban, or rivaroxaban) in Ontario, Canada, from June 23, 2009, to December 31, 2016. Cox proportional hazards regression was used to examine the association between hemorrhage and antibiotic use (clarithromycin vs azithromycin). Statistical analysis was performed from December 23, 2019, to March 25, 2020. Main Outcomes and Measures: Hospital admission with major hemorrhage (upper or lower gastrointestinal tract or intracranial). Outcomes were assessed within 30 days of a coprescription. Results: Among the 24 943 patients (12 493 women; mean [SD] age, 77.6 [7.2] years) in the study, rivaroxaban was the most commonly prescribed DOAC (9972 patients [40.0%]), followed by apixaban (7953 [31.9%]) and dabigatran (7018 [28.1%]). Coprescribing clarithromycin vs azithromycin with a DOAC was associated with a higher risk of a hospital admission with major hemorrhage (51 of 6592 patients [0.77%] taking clarithromycin vs 79 of 18 351 patients [0.43%] taking azithromycin; adjusted hazard ratio, 1.71 [95% CI, 1.20-2.45]; absolute risk difference, 0.34%). Results were consistent in multiple additional analyses. Conclusions and Relevance: This study suggests that, among adults of advanced age taking a DOAC, concurrent use of clarithromycin compared with azithromycin was associated with a small but statistically significantly greater 30-day risk of hospital admission with major hemorrhage.
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