Abstract
Initiation of statin treatment is suggested to increase the
international normalised ratio (INR) among warfarin users. However,
available data is limited and conflicting. We conducted a register-based
cohort study to evaluate the drug-drug interaction between warfarin and
statins. By linking data on INR measurements and filled prescriptions,
we identified warfarin users 2000-2015 initiating simvastatin (n=1,363),
atorvastatin (n=165), or rosuvastatin (n=23). Simvastatin initiation led
to an increase in mean INR from 2.40 to 2.71, with INRs peaking after 4
weeks, corresponding to a mean change of 0.32 (95%CI 0.25-0.38).
High-dose and low-dose simvastatin led to comparable changes (mean
change 0.33 vs 0.29). Initiation of atorvastatin and rosuvastatin lead
to INR increases of 0.27 (95%CI 0.12-0.42) and 0.30 (95%CI
-0.09-0.69). In conclusion, initiation of simvastatin, atorvastatin, or
rosuvastatin among warfarin users led to a minor increase in INR. The
magnitude of this change is for most patients likely of limited clinical
relevance.