Overanticoagulation with Coumarin and Cutaneous Azole Therapy
Authors: Jean-François Alexandra, Eric Pautas, Isabelle Gouin-Thibault, Virginie Siguret, Marie-Anne Loriot
Journal: Annals of Internal Medicine (2008)

Letters15 April 2008Overanticoagulation with Coumarin and Cutaneous Azole TherapyJean-François Alexandra, MD, Eric Pautas, MD, Isabelle Gouin-Thibault, PhD, Virginie Siguret, MD, and Marie-Anne Loriot, PhDJean-François Alexandra, MDFrom Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.Search for more papers by this author, Eric Pautas, MDFrom Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.Search for more papers by this author, Isabelle Gouin-Thibault, PhDFrom Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.Search for more papers by this author, Virginie Siguret, MDFrom Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.Search for more papers by this author, and Marie-Anne Loriot, PhDFrom Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-8-200804150-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Overanticoagulation is a major concern in elderly patients receiving coumarin therapy. Potentiation of coumarin anticoagulants by systemic azole antifungal agents is well documented. However, few data are available about coumarin interactions with topical azole agents (1–3).Objective: To describe 6 cases of overanticoagulation with coumarin therapy in patients treated with topical azole.Methods: Over 25 months in an 800-bed geriatric teaching hospital, all patients older than 80 years of age with an international normalized ratio (INR) greater than 5.0 who were receiving coumarin were screened for cutaneous azole use. We defined day 0 as the first day with INR ...References1. Visser LE, Penning-van Beest FJ, Kasbergen AA, De Smet PA, Vulto AG, Hofman A, et al. Overanticoagulation associated with combined use of antifungal agents and coumarin anticoagulants. Clin Pharmacol Ther. 2002;71:496-502. [PMID: 12087353] CrossrefMedlineGoogle Scholar2. Devaraj A, O'Beirne JP, Veasey R, Dunk AA. Interaction between warfarin and topical miconazole cream. BMJ. 2002;325:77. [PMID: 12114237] CrossrefMedlineGoogle Scholar3. Lang PG, LeClercq AH. Increase in anticoagulant effect of warfarin in a patient using econazole cream [Letter]. J Am Acad Dermatol. 2006;55:S117-9. [PMID: 17052529] CrossrefMedlineGoogle Scholar4. Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med. 2005;165:1095-106. [PMID: 15911722] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorrection: Overanticoagulation with Coumarin and Cutaneous Azole Therapy Metrics Cited byCoumarin anticoagulantsMiconazole buccal gel and risk for systemic bleeding: how certain topical formula can interfere with anticoagulantsPhase I Study of the Novel Antifungal Agent Dapaconazole (Zilt®) in Healthy VolunteersReversal of Overanticoagulation in Very Elderly Hospitalized Patients with an INR above 5.0: 24-Hour INR Response after Vitamin K AdministrationDermocorticoïdesDermocorticoidesInteraction between topical miconazole and coumarinsDrugs that affect blood coagulation, fibrinolysis, and hemostasisAtteinte musculaire à la suite d’une interaction entre la simvastatine et la crème de bifonazoleCorrection: Overanticoagulation with Coumarin and Cutaneous Azole Therapy 15 April 2008Volume 148, Issue 8Page: 633-635KeywordsAllelesCoumarinsElderlyGeriatricsHemorrhagePneumoniaRoutes of administrationVitamin K ePublished: 15 April 2008 Issue Published: 15 April 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...