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Possible mechanism for fluoroquinolone-induced aortopathy uncovered

Guzzardi DG et al. J Thorac Cardiovasc Surg. 2019;157:109-19.

Key clinical point: Fluoroquinolone exposure decreased tissue inhibitors of matrix metalloproteinases (TIMP) expression and impaired compensatory collagen type I expression, resulting in human aortic myofibroblast–mediated extracellular matrix dysregulation.

Major finding: The ratio of matrix metalloproteinase 9/TIMP-2 increased, suggesting an increased capacity for extracellular matrix degradation (P less than .01).

Study details: Human aortic myofibroblasts were isolated from nine patients with aortopathy undergoing elective ascending aortic resection.

Disclosures: The authors reported that they had no commercial conflicts to disclose.

Citation:

Guzzardi DG et al. J Thorac Cardiovasc Surg. 2019;157:109-19.

Commentary:

The issue of fluoroquinolones is certainly of concern. I wonder how many of my patients who have suffered a ruptured aneurysm were on one of these drugs? In the last few years, Cipro (ciprofloxacin) and Levaquin (levofloxacin) were commonly used by our family practice and internal medicine colleagues for almost all outpatient infections. It was so common that even my wife, who is not a physician, would request Cipro whenever she had a sneeze. We would also bring large bottles of Cipro every time we went traveling to some exotic destination, reassuring ourselves that the only “runs” we would have would be in the airport trying to catch a flight. A cousin of mine, prescribed Levaquin by a well-meaning physician while he was cruising the Nile River, ruptured his Achilles tendon.

Clearly, these medications do bad things to collagen, and we should avoid them in all patients who are at risk for aneurysmal development. I am unsure about the medicolegal responsibility for informing outpatients, however, our practice has put out an email blast to all patients who have aneurysms or are at risk for an aneurysm, informing them of the dangers of these drugs.

Russell H. Samson, MD, FACS, DFSVS , is a clinical professor of surgery at Florida State University, Sarasota, a senior surgeon at Sarasota Vascular Specialists, and President of the Mote Vascular Foundation.

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