Ceftriaxone and Warfarin Interaction

Patient Assessment and Monitoring

• The American Heart Association, as published in Circulation, recommends assessing patients for additional bleeding risk factors, such as age, history of bleeding, and concomitant antiplatelet agents, when considering ceftriaxone in patients on warfarin 1, 2
• Patients on multiple antithrombotic agents, including warfarin and antiplatelet drugs, have a compounded bleeding risk, according to the American College of Cardiology 1, 3

Bleeding Risk Mitigation

• The American College of Cardiology recommends considering alternative antibiotics, such as cefixime, in patients with a history of major bleeding on warfarin 2
• Patients at high bleeding risk receiving warfarin and ceftriaxone should consider adding a proton pump inhibitor for gastric protection, particularly if on multiple antithrombotic agents 3