Key result
Among atrial fibrillation patients taking oral anticoagulants, initiation of selective serotonin reuptake inhibitors was associated with an increased risk of bleeding compared to serotonin/norepinephrine reuptake inhibitors (HR 1.22).
Why the study?
Evidence has been inconsistent regarding whether certain antidepressants, particularly SSRIs, increase bleeding risk in patients taking oral anticoagulants.
Does the type of antidepressant initiated affect the risk of hospitalized bleeding in atrial fibrillation patients taking oral anticoagulants?
Cohort (n=30,336)
Does the type of antidepressant initiated affect the risk of hospitalized bleeding in atrial fibrillation patients taking oral anticoagulants?
Hazard Ratio: 1.22 (95% CI 0.96–1.54)
Absolute Event Rate: 3.18% vs 2.62%
Among atrial fibrillation patients taking oral anticoagulants, initiation of SSRIs is associated with a higher risk of bleeding compared to other antidepressants, whereas SNRIs are associated with the lowest risk.
SSRI initiation may raise bleeding risk versus alternatives in AF patients on OAC; leaves open whether type-specific selection improves net outcomes.
BACKGROUND: Inconsistent evidence suggests that use of certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), in patients using oral anticoagulants (OACs) might be associated with an elevated risk of bleeding. OBJECTIVE: This study aims to investigate the risk of bleeding associated with initiation of different types of antidepressants among atrial fibrillation (AF) patients on OAC therapy. PATIENTS AND METHODS: A total of 30,336 AF patients (mean age 72.2 years; 54% female) on OAC therapy that started antidepressant treatment were identified from the Truven Health Analytics MarketScan Commercial and Medicare Databases for the period 2007-2015. Exposure was defined as filling a prescription for antidepressant, and categorized as SSRI, serotonin/norepinephrine reuptake inhibitors (SNRIs), serotonin reuptake inhibitors (SRIs), tricyclic antidepressants (TCAs), or other antidepressants. The primary outcome was incident hospitalized bleeding. Associations of antidepressant type with bleeding were assessed calculating hazard ratios (HRs) and 95% confidence intervals (CIs) with adjusted Cox models in pairwise propensity score-matched cohorts. RESULTS: During a mean follow-up of 21 months, we identified 1612 bleeding episodes. In pairwise comparisons, SSRI use was associated with an increased risk of bleeding when compared to most other antidepressants (HR 1.22, 95% CI 0.96-1.54 vs SNRI; HR 1.10, 95% CI 0.90-1.35 vs SRI; HR 1.03, 95% CI 0.82-1.30 vs TCA). SNRI use was associated with the lowest bleeding risk. Results did not differ by OAC type, age, and sex. CONCLUSIONS: Among AF patients on OAC initiating antidepressants, risk of bleeding varied across antidepressant type. This information can inform treatment choices among patients receiving OAC.
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Shao et al. (2021) conducted a cohort in Atrial fibrillation on oral anticoagulant therapy (n=30,336). Selective serotonin reuptake inhibitors (SSRIs) vs. Serotonin/norepinephrine reuptake inhibitors (SNRIs) was evaluated on Incident hospitalized bleeding (HR 1.22, 95% CI 0.96-1.54). Among atrial fibrillation patients taking oral anticoagulants, initiation of selective serotonin reuptake inhibitors was associated with an increased risk of bleeding compared to serotonin/norepinephrine reuptake inhibitors (HR 1.22).
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