Assessing evidence of interaction between smoking and warfarin: a systematic review and meta-analysis.

نویسندگان

  • Surakit Nathisuwan
  • Piyameth Dilokthornsakul
  • Nathorn Chaiyakunapruk
  • Tatiya Morarai
  • Thararat Yodting
  • Nichakorn Piriyachananusorn
چکیده

BACKGROUND Chronic smoking, theoretically, can interfere with warfarin metabolism through enzyme-inducing effects of polycyclic aromatic hydrocarbons. However, clinical evidence of interactions between warfarin and smoking are inconclusive. This study aimed to systematically review all relevant clinical evidence of this interaction. METHODS We performed a systematic search using computerized databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine, PsycINFO, International Pharmaceutical Abstracts, and ClinicalTrials.gov from 1966 to December 2008. Keywords included "warfarin" with "smoking," "tobacco," "cigarette," and "polycyclic aromatic hydrocarbons." Original articles reporting interaction between warfarin and smoking were included. All articles were reviewed independently by two investigators for study design, population, outcomes, and quality of evidence. RESULTS Of the 1,240 studies retrieved, one experimental pharmacokinetic study and 12 cross-sectional studies were included. The pooled analyses of multivariate studies suggested that smoking was associated with a 12.13% (95% CI, 6.999-17.265; P < .001) increase in warfarin dosage requirement and an additional 2.26 mg (95% CI, 2.529-7.042; P = .355) per week compared with nonsmoking. Additional sensitivity analysis of four multivariate studies with adjustment for pharmacogenomic factors suggested that smoking was associated with a 13.21% (95% CI, 8.59%-17.83%; P < .001) increase in warfarin dosage requirement compared with nonsmokers. Results of an experimental pharmacokinetic study lend theoretical support to the findings. CONCLUSIONS Evidence suggests that smoking may potentially cause significant interaction with warfarin by increasing warfarin clearance, which leads to reduced warfarin effects. Close monitoring of warfarin therapy should be instituted when there is a change in smoking status of patients requiring warfarin therapy.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Cigarette Smoking and Pachymetry and Specular Microscopy Parameters of Cornea; A Systematic Review and Meta-analysis

Purpose: To investigate the effect of smoking on corneal parameters, including Endothelial Cell Density, Central Corneal Thickness, Percent of Hexogonality, and Coefficient of Variation. Methods: This study was a systematic review and meta-analysis of published articles until the end of February 2019. To do this, the first search was done for creditable medical databases such as PubMed, and ISI...

متن کامل

Effectiveness of hypnosis in the treatment of pain and enhancing mental performance in Iran: A systematic review and meta-analysis

Background and aims: Nowadays, hypnosis has opened its position in the medical community. Based on controlled trials, hypnosis has been superior compared to other interventional procedures to reduce acute pain. This investigation aims to determine the effectiveness of hypnosis in the treatment of pain and enhancing mental performance in Iran, using the meta-analysis method. <br...

متن کامل

Prevalence of cigarette smoking among Iranian women: a systematic review and meta-analysis

  Background: Smoking has physical, psychological, and social impacts on women’s health and subsequently the community’s health. Therefore, it is important to have an estimation of smoking among Iranian women.   Since comprehensive data are not available in this respect, the authors performed a systematic review and metaanalyzed all high-quality studies in this field.   Methods: All available e...

متن کامل

Acellular pertussis vaccine efficacy: An updated systematic review and meta –analysis

Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. &nbsp; Methods: We performed a syste...

متن کامل

Prevalence of Comorbidities in COVID-19 Patients: A Systematic Review and Meta-Analysis

Background: In this study, we aimed to assess the prevalence of comorbidities in the confirmed COVID-19 patients. Thismight help showing which comorbidity might pose the patients at risk of more severe symptoms.Methods: We searched all relevant databases on April 7th, 2020 using the keywords (“novel coronavirus” OR COVID-19OR SARS-CoV-2 OR Coronavirus) AND (comorbidities OR cl...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Chest

دوره 139 5  شماره 

صفحات  -

تاریخ انتشار 2011