Antidepressant Use and Risk of Venous Thromboembolism: A Systematic Review and Meta-Analysis

PURPOSE: Studies provided conflicting results on whether antidepressant use increased the risk of venous thromboembolism (VTE). Our aim was to examine the association between antidepressant use and the risk of VTE. METHODS: Pubmed, Embase, and the Cochrane Library were searched up to March 13, 2018. Case-control studies and cohort studies that examined the association between antidepressant use and the risk of VTE, deep vein thrombosis or pulmonary embolism were included. Several subgroup analyses and sensitivity analyses were conducted. GRADE approach was used to assess the quality of evidence. RESULTS: Nine studies (six case-control studies and three cohort studies) were included. Overall, antidepressant use may be associated with an increased risk of VTE (OR 1.27, 95% CI 1.09 to 1.49); however, no association was observed in studies with low risk of bias (OR 1.27, 95% CI 0.84 to 1.92). No association between selective serotonin reuptake inhibitor use and VTE risk was detected in the overall analysis (OR 1.10, 95% CI 0.90 to 1.34) and in subgroup analysis of studies with low risk of bias. Tricyclic antidepressant may be associated with an increased VTE risk (OR 1.26, 95% CI 1.02 to 1.57), and the quality of evidence was rated as very low by GRADE approach; however, no association was observed when we only included studies with low risk of bias. CONCLUSIONS: There was no association between selective serotonin reuptake inhibitor use and VTE risk. Tricyclic antidepressant may be associated with an increased VTE risk, but the quality of evidence was very low.