Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Cardiol. 2014 Aug 15;114(4):583-6. doi: 10.1016/j.amjcard.2014.05.037. Epub 2014 Jun 5.

Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin.

Author information

1
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: gene.quinn@mail.harvard.edu.
2
Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts.
3
Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
4
Division of Research, Kaiser Permanente Northern California, Oakland, California.
5
Division of Hospital Medicine, University of California, San Francisco, San Francisco, California.

Abstract

Selective serotonin reuptake inhibitor (SSRI) medications have been linked to increased bleeding risk; however, the actual association among warfarin, SSRI exposure, and bleeding risk has not been well-established. We studied the AnTicoagulation and Risk factors In Atrial fibrillation cohort of 13,559 adults with atrial fibrillation, restricted to the 9,186 patients contributing follow-up time while taking warfarin. Exposure to SSRIs and tricyclic antidepressants (TCAs) was assessed from pharmacy database dispensing data. The main outcome was hospitalization for major hemorrhage. Results were adjusted for bleeding risk and time in international normalized ratio range >3. We identified 461 major hemorrhages during 32,888 person-years of follow-up, 45 events during SSRI use, 12 during TCA-only use, and 404 without either medication. Hemorrhage rates were higher during periods of SSRI exposure compared with periods on no antidepressants (2.32 per 100 person-years vs 1.35 per 100 person-years, p <0.001) and did not differ between TCA exposure and no antidepressants (1.30 per 100 person-years on TCAs, p = 0.94). After adjustment for underlying bleeding risk and time in international normalized ratio range >3, SSRI exposure was associated with an increased rate of hemorrhage compared with no antidepressants (adjusted relative risk 1.41, 95% confidence interval 1.04 to 1.92, p = 0.03), whereas TCA exposure was not (adjusted relative risk 0.82, 95% confidence interval 0.46 to 1.46, p = 0.50). In conclusion, SSRI exposure was associated with higher major hemorrhage risk in patients taking warfarin, and this risk should be considered when selecting antidepressant treatments in those patients.

PMID:
25001151
PMCID:
PMC5176251
DOI:
10.1016/j.amjcard.2014.05.037
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Dr. Singer has consulted for Bayer Healthcare, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, and Pfizer, and has received research support from Daiichi Sanyo and Johnson & Johnson. Dr. Quinn has no conflicts of interest. Dr. Chang has no conflicts of interest. Dr. Go has no conflicts of interest. Ms. Borowsky has no conflicts of interest. Dr. Udaltsova has no conflicts of interest. Dr. Fang has no conflicts of interest.

PubMed Commons home

PubMed Commons

0 comments

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center