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

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.

• Authors: Gene R Quinn, Daniel E Singer, Yuchiao Chang, Alan S Go, Leila H Borowsky, Natalia Udaltsova, Margaret C Fang
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 114 Issue 4 Pg. 583-6 (Aug 15 2014) ISSN: 1879-1913 [Electronic] United States
• PMID: 25001151 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Serotonin Uptake Inhibitors
• Warfarin

Topics

• Adult
• Aged
• Anticoagulants (adverse effects, therapeutic use)
• Atrial Fibrillation (complications, therapy)
• Depression (complications, drug therapy)
• Female
• Follow-Up Studies
• Hemorrhage (chemically induced, epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Selective Serotonin Reuptake Inhibitors (adverse effects, therapeutic use)
• Thromboembolism (etiology, prevention & control)
• Time Factors
• United States (epidemiology)
• Warfarin (adverse effects, therapeutic use)