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Overanticoagulation with Coumarin and Cutaneous Azole Therapy
- Jean-François Alexandra, MD;
- Eric Pautas, MD;
- Isabelle Gouin-Thibault, PhD;
- Virginie Siguret, MD; and
- Marie-Anne Loriot, PhD
- From Hôpital Charles Foix, Ivry-sur-Seine 94205, France, and INSERM U775, Université Paris Descartes, 75006 Paris, France.
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 greater than 5.0. For each patient, we collected demographic, clinical, and therapeutic data (especially on use of concomitant medications that might potentiate coumarin) at least 15 days before and after day 0 (4). We …
