{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:46:36Z","timestamp":1792759596967,"version":"4.5.0"},"reference-count":15,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["amjmed.com","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The American Journal of Medicine"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.amjmed.2026.08.034","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:49:40Z","timestamp":1790434180000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["An unresolved signal: Fluoroquinolones, aortic disease, and the limits of pharmacoepidemiology"],"prefix":"10.1016","author":[{"given":"John G.","family":"Rizk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-2986","authenticated-orcid":false,"given":"G. Caleb","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.amjmed.2026.08.034_bib0001","doi-asserted-by":"crossref","DOI":"10.1001\/jamainternmed.2015.5389","article-title":"Risk of aortic dissection and aortic aneurysm in patients taking oral fluoroquinolone","volume":"175","author":"Lee","year":"2015","journal-title":"Jama Intern Med"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0002","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010077","article-title":"Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study","volume":"5","author":"Daneman","year":"2015","journal-title":"BMJ Open"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0003","article-title":"Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study","volume":"360","author":"Pasternak","year":"2018","journal-title":"BMJ Online"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0004","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacc.2018.06.067","article-title":"Oral fluoroquinolone and the risk of aortic dissection","volume":"72","author":"Lee","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2024-002925","article-title":"Impact of the US food and drug administration warning regarding increased risk of aortic aneurysms or aortic dissections on fluoroquinolone prescribing trends","volume":"13","author":"Rizk","year":"2024","journal-title":"BMJ Open Qual"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0006","unstructured":"Healio. FDA: fluoroquinolones increase odds of aortic dissection, AAA rupture. Published December 20, 2018. Accessed July 31, 2026. https:\/\/www.healio.com\/news\/cardiology\/20181220\/fda-fluoroquinolones-increase-odds-of-aortic-dissection-aaa-rupture."},{"key":"10.1016\/j.amjmed.2026.08.034_bib0007","unstructured":"Centers for Disease Control and Prevention. Outpatient antibiotic use: retail pharmacy prescription data. Antimicrobial resistance & patient safety portal. Accessed August 7, 2026. https:\/\/arpsp.cdc.gov\/profile\/antibiotic-use\/fluoroquinolones."},{"key":"10.1016\/j.amjmed.2026.08.034_bib0008","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-020-01354-y","article-title":"Relationship between fluoroquinolones and the risk of aortic diseases: a meta-analysis of observational studies","volume":"20","author":"Dai","year":"2020","journal-title":"BMC Cardiovasc Disord"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0009","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics10060697","article-title":"The association between the risk of aortic aneurysm\/aortic dissection and the use of fluroquinolones: a systematic review and meta-analysis","author":"Lai","year":"2021","journal-title":"Antibiotics"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0010","article-title":"Do fluoroquinolones increase aortic aneurysm or dissection incidence and mortality? A systematic review and meta-analysis","author":"Chen","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0011","doi-asserted-by":"crossref","DOI":"10.1001\/jamacardio.2023.2418","article-title":"Association between fluoroquinolone use and hospitalization with aortic aneurysm or aortic dissection","author":"Brown","year":"2023","journal-title":"Jama Cardiol"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0012","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2025.103096","article-title":"Risk of aortic aneurysm or dissection following use of fluoroquinolones: a retrospective multinational network cohort study","volume":"81","author":"Janetzki","year":"2025","journal-title":"EClinicalMedicine"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0013","doi-asserted-by":"crossref","DOI":"10.1002\/phar.70020","article-title":"Fluoroquinolones and the risk of aortic aneurysm or dissection: a population-based propensity score-matched German cohort study","volume":"45","author":"Wicherski","year":"2025","journal-title":"Pharmacotherapy"},{"key":"10.1016\/j.amjmed.2026.08.034_bib0014","doi-asserted-by":"crossref","unstructured":"Z.N Efe, M.A. Husain Ciprofloxacin and aortic aneurysm rupture: innocent bystander or true culprit? Am J Med. Published online August 18, 2026. doi:10.1016\/j.amjmed.2026.07.044.","DOI":"10.1016\/j.amjmed.2026.07.044"},{"issue":"5","key":"10.1016\/j.amjmed.2026.08.034_bib0015","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2026.14282","article-title":"The unfinished science of boxed drug warnings","volume":"9","author":"Rizk","year":"2026","journal-title":"Jama Netw Open"}],"container-title":["The American Journal of Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002934326006820?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002934326006820?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:26:36Z","timestamp":1792758396000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0002934326006820"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"alternative-id":["S0002934326006820"],"URL":"https:\/\/doi.org\/10.1016\/j.amjmed.2026.08.034","relation":{},"ISSN":["0002-9343"],"issn-type":[{"value":"0002-9343","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"An unresolved signal: Fluoroquinolones, aortic disease, and the limits of pharmacoepidemiology","name":"articletitle","label":"Article Title"},{"value":"The American Journal of Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.amjmed.2026.08.034","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"simple-article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}