Key result
Concomitant use of SSRIs and oral anticoagulants was associated with an increased risk of major bleeding compared with oral anticoagulant use alone (HR 1.35; 95% CI 1.14-1.58).
Why the study?
SSRIs carry a modestly increased major bleeding risk, but in patients treated with both SSRIs and oral anticoagulants, the risk may be substantial.
Does concomitant use of SSRIs and oral anticoagulants increase the risk of major bleeding compared to oral anticoagulants alone?
Meta-Analysis (n=98,070)
Does concomitant use of SSRIs and oral anticoagulants increase the risk of major bleeding compared to oral anticoagulants alone?
Hazard Ratio: 1.35 (95% CI 1.14–1.58)
Concomitant use of SSRIs and oral anticoagulants significantly increases the risk of major bleeding compared to oral anticoagulants alone, highlighting the need for individualized bleeding risk assessment.
Warrants bleeding risk reassessment with SSRI addition to OACs; confirms elevated risk in pooled analyses.
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs), the most prescribed antidepressants, are associated with a modestly increased risk of major bleeding. However, in patients treated with both SSRIs and oral anticoagulants (OACs), the risk of major bleeding may be substantial. OBJECTIVE: To assess the risk of major bleeding associated with concomitant use of SSRIs and OACs, compared with OAC use alone. METHODS: We searched MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (from inception to December 1, 2021) for clinical trials and observational studies assessing the association between concomitant use of SSRIs and OACs and the risk of major bleeding. Given sufficient homogeneity of studies, we conducted a random-effects meta-analysis to estimate a pooled hazard ratio (HR) of major bleeding associated with concomitant use of SSRIs and OACs, compared with OAC use alone. RESULTS: The review comprised 14 studies, including 7 cohort and 7 nested case-control studies. Following assessment of clinical and methodological heterogeneity, eight studies with a total of 98,070 patients were eligible for the meta-analysis. The pooled HR of major bleeding associated with concomitant use of SSRIs and OACs was 1.35 (95% confidence interval [CI]: 1.14-1.58). In secondary analyses, the pooled HR for concomitant use of SSRIs and direct OACs was 1.47 (95% CI: 1.03-2.10). CONCLUSION: Concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding. Overall, our findings suggest that physicians may need to tailor treatment according to individual patient risk factors for bleeding when prescribing SSRIs to patients using OACs.
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Rahman et al. (2022) conducted a meta-analysis in Patients treated with oral anticoagulants (n=98,070). Concomitant use of SSRIs and oral anticoagulants vs. Oral anticoagulant use alone was evaluated on Major bleeding (HR 1.35, 95% CI 1.14-1.58). Concomitant use of SSRIs and oral anticoagulants was associated with an increased risk of major bleeding compared with oral anticoagulant use alone (HR 1.35; 95% CI 1.14-1.58).
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