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Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin
- Source :
- The American journal of cardiology, vol 114, iss 4
- Publication Year :
- 2014
- Publisher :
- eScholarship, University of California, 2014.
-
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 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 riskshould be considered when selecting antidepressant treatments in those patients.
- Subjects :
- Adult
Male
Time Factors
Hemorrhage
Cardiorespiratory Medicine and Haematology
Cardiovascular
Risk Factors
Clinical Research
Thromboembolism
Atrial Fibrillation
Humans
Retrospective Studies
Aged
Depression
Incidence
Anticoagulants
Middle Aged
United States
Brain Disorders
Mental Health
Cardiovascular System & Hematology
Serotonin Uptake Inhibitors
Female
Warfarin
Selective Serotonin Reuptake Inhibitors
Follow-Up Studies
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- The American journal of cardiology, vol 114, iss 4
- Accession number :
- edsair.od.......325..4ecdd1b7bf4af00f2f58e267a97d58bc