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Sulfonylureas and Metformin Were Not Associated With an Increased Rate of Serious Bleeding in Warfarin Users: A Self‐Controlled Case Series Study
Author(s) -
Nam Young Hee,
Han Xu,
Brensinger Colleen M.,
Bilker Warren B.,
Leonard Charles E.,
Hennessy Sean
Publication year - 2020
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.1885
Subject(s) - medicine , warfarin , metformin , concomitant , confidence interval , glimepiride , glipizide , gastrointestinal bleeding , atrial fibrillation , insulin
Drug interactions between warfarin and sulfonylureas are suggested by pharmacokinetic information and prior studies. However, clinical evidence on the association of such interactions and the risk of bleeding is lacking. Using healthcare claims data from 5 US Medicaid programs from 1999–2011 and a self‐controlled case series design with warfarin as an object drug, we calculated confounder‐adjusted rate ratios (RRs) for concomitant use of sulfonylureas and metformin for 3 outcomes separately: (i) serious bleeding as a composite outcome of gastrointestinal bleeding (GIB) and nontraumatic intracranial hemorrhage (ICH); (ii) GIB; and (iii) ICH. In 6,463 warfarin users experiencing serious bleeding, an increased rate of serious bleeding was not associated with concomitant use of glimepiride (RR: 0.93; 95% confidence interval (CI) 0.75–1.15), glipizide (RR: 0.97; 95% CI 0.84–1.13), glyburide (RR: 0.89; 95% CI 0.76–1.06), or metformin (RR: 0.85; 95% CI 0.76–0.96), nor was the occurrence of the component outcomes of GIB or ICH. These results suggest that use of sulfonylureas or metformin was not associated with an increased rate of serious bleeding in warfarin users.