JAMA Netw Open
SSRIs + oral anticoagulants increases bleeding risk, suggests study
Among patients with afib in this nested case-control study, concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding compared with OAC use alone. The findings suggest that close monitoring and management of risk factors for bleeding are required, especially in the first few months of use.
- This UK population-based, nested case-control study was conducted among patients with afib initiating OACs between January 1998 and March 2021. For each case of major bleeding during follow-up, up to 30 controls were selected and matched on age, sex, cohort entry date, and follow-up duration. Primary outcome was incidence rate ratios (IRRs) of hospitalization for bleeding or death due to bleeding.
- A total of 42,190 patients with major bleeding (mean age, 74.2 years; 59.8% men) were matched to 1,156,641 controls. Concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding vs. OACs alone (IRR, 1.33; 95% confidence interval [CI], 1.24-1.42). Risk peaked during the initial months of treatment (first 30 days of use: IRR, 1.74; 95% CI, 1.37-2.22) and persisted for up to 6 months. Risk didn’t vary with age, sex, history of bleeding, CKD, and potency of SSRIs. An association was observed both with concomitant use of SSRIs and direct OACs vs. direct OAC use alone (IRR, 1.25; 95% CI, 1.12-1.40) and concomitant use of SSRIs and VKAs vs. VKA use alone (IRR, 1.36; 95% CI, 1.25-1.47).
Source:
Rahman AA, et al. (2024, March 22). JAMA Netw Open. Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding. https://pubmed.ncbi.nlm.nih.gov/38517440/