Why the study?
The study aimed to quantify the effects of antidepressant use in oral anticoagulant-treated patients with atrial fibrillation.
Does concomitant antidepressant use increase the risk of severe bleeds and strokes in atrial fibrillation patients treated with oral anticoagulants?
Does concomitant antidepressant use increase the risk of severe bleeds and strokes in atrial fibrillation patients treated with oral anticoagulants?
Concomitant use of antidepressants and oral anticoagulants in patients with atrial fibrillation significantly increases the risk of severe bleeding without significantly affecting stroke risk.
May warrant vigilance with antidepressants in OAC-treated AF; leaves open causal effects and practice implications.
We aimed to quantify the effects of antidepressant (AD) use in oral anticoagulant (OAC)-treated patients with atrial fibrillation (AF). Using the Stockholm Healthcare database, we analyzed AF patients initiated with an OAC. Outcomes were severe bleeds and strokes and were analyzed using Cox models. We included 17,210 patients claiming warfarin and 13,385 claiming a non-vitamin K OAC. The number of patients that claimed an AD during follow-up was 4,303. Concomitant OAC and AD use was associated with increased rates of severe bleeds (4.7 vs. 2.7 per 100 person-years) compared with OAC treatment alone (adjusted hazard ratio (aHR) 1.42, confidence interval (CI): 1.12-1.80), but not significantly associated with increased stroke rates (3.5 vs. 2.1 per 100 person-years, aHR 1.23, CI: 0.93-1.62). No significant differences in risks were observed between different OAC classes or different AD classes. In conclusion, concomitant use of an OAC and an AD is associated with an increased bleeding risk.
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Komen et al. (2019) studied this question.
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