May 26, 2024

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Simultaneous Use of SSRIs and Oral Anticoagulants Increases Risk of Major Bleeding by 33%

Simultaneous Use of SSRIs and Oral Anticoagulants Increases Risk of Major Bleeding by 33%



Simultaneous Use of SSRIs and Oral Anticoagulants Increases Risk of Major Bleeding by 33%

Selective serotonin reuptake inhibitors (SSRIs) are widely used antidepressants that also have an antiplatelet effect, which may increase the risk of major bleeding. However, for most patients using SSRIs, the absolute risk is low.

Some observational studies have assessed the association between concomitant use of SSRIs and oral anticoagulants (OACs) and the risk of major bleeding, but there are limitations such as misclassification and residual confounding.

Therefore, researchers at McGill University conducted a population-based nested case-control study to assess whether the simultaneous use of SSRIs and OACs is associated with an increased risk of major bleeding compared to using OACs alone in patients with atrial fibrillation (AF).

42190 cases of major bleeding were matched with 1156641 controls. Compared to using OACs alone, simultaneous use of SSRIs and OACs was associated with a 33% increase in the risk of major bleeding, which persisted for up to 6 months and did not vary with factors such as age, sex, bleeding history, etc.

The study was published in JAMA Network Open.

Simultaneous Use of SSRIs and Oral Anticoagulants Increases Risk of Major Bleeding by 33%

The study data came from the UK’s large primary care electronic health record databases (CPRD GOLD and Aurum databases) and included patients aged 18 and above diagnosed with AF between January 2, 1998, and March 29, 2021, who were prescribed OACs after diagnosis, excluding patients who used OACs before enrollment or SSRIs in the 6 months before enrollment, and followed up until the first major bleeding event, death, or end of the study (March 29, 2021). Patients who received both SSRIs and OACs in the 30 days before the index date were defined as simultaneous users.

During a mean follow-up of 4.6 years, 42391 patients were hospitalized for major bleeding, of which 42190 cases were matched with 1156641 controls. Simultaneous use of SSRIs and OACs was associated with a 33% increase in the risk of major bleeding compared to using OACs alone; the risk of major bleeding was highest in the first 30 days of treatment, with an IRR of 1.74, followed by a slow decline, and the increased risk persisted for 6 months, without changes in age, sex, bleeding history, chronic kidney disease, or SSRI efficacy.

In stratified analysis, the risk of major bleeding associated with direct oral anticoagulants (DOACs) was lower compared to traditional OACs like vitamin K antagonists (VKAs). Compared to using OACs alone, simultaneous use of SSRIs and VKAs was associated with a 36% increase in the risk of major bleeding, while simultaneous use of SSRIs and DOACs was associated with a 25% increase in risk.

Interaction assessment showed that there may be a certain superadditive interaction between SSRIs and OACs, but it was not significant.

Overall, patients taking SSRIs and OACs simultaneously should consider the risk of major bleeding, especially in the first few months of combined use. However, the risk of major bleeding does not mean stopping SSRI or OAC treatment, and measures can be taken to minimize the risk of major bleeding, such as choosing a lower-risk DOAC.

Simultaneous Use of SSRIs and Oral Anticoagulants Increases Risk of Major Bleeding by 33%

Referecnes:

Rahman A A, Platt R W, Beradid S, et al. Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding[J]. JAMA Network Open, 2024, 7(3): e243208-e243208.

(source:internet, reference only)


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