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Undesirable Synergy

William R. Bell, MD

JAMA. 1998;279:702-703.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

During the past 25 years, because of the important concern of bleeding associated with the use of aspirin via irreversible induced platelet dysfunction, the use of acetaminophen has steadily increased. Although acetaminophen is used primarily for its analgesic and antipyretic properties, this ubiquitous drug is taken by many for a wide range of nonspecific conditions as well. In the United States, acetaminophen is the most frequently ingested medication.¹

In this issue of JAMA, Hylek et al,² in searching for the cause of unexpected dangerously elevated international normalized ratio (INR) in patients taking warfarin for anticoagulation, identified that 56% of patients with dangerously elevated INRs had also been taking acetaminophen. Several additional factors independently influenced the INR, including advanced malignancy, ingesting more warfarin than prescribed, decreased oral intake of liquids and solids, acute diarrheal illness, alcohol consumption, and vitamin K intake. The mechanisms by which several . . . [Full Text of this Article]

From the Johns Hopkins University School of Medicine, Baltimore, Md.

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