Weinrieb Robert M, Auriacombe Marc, Lynch Kevin G, Chang Kyong-Mi, Lewis James D
Department of Psychiatry, University of Pennsylvania, Philadelphia, USA.
J Clin Psychiatry. 2003 Dec;64(12):1502-10. doi: 10.4088/jcp.v64n1215.
Selective serotonin reuptake inhibitors (SSRIs) are increasingly being used to treat interferon-associated side effects in patients receiving hepatitis C virus (HCV) therapy. Because there is an increased risk of bleeding in HCV-infected patients who have developed cirrhosis and either portal hypertension or hepatic failure or both, we critically reviewed the literature on SSRI-associated bleeding.
We performed a MEDLINE search of literature from 1966 to the present using hemorrhage, SSRI, and antidepressants as search terms and followed up on relevant citations. We reviewed 6 retrospective studies, 5 of which were case-control studies, and 18 case reports of bleeding in 37 people. Our review is supplemented with a case report of a possible connection between SSRI treatment and a fatal gastrointestinal bleed in an HCV-infected man.
Bleeding events in 12/18 reports (67%) describing 19/24 people (79%) were closely associated with the use of SSRIs.
Combining aspirin or nonsteroidal anti-inflammatory drugs with SSRIs for the treatment of interferon-associated neuropsychiatric side effects increases the risks of hemorrhage in patients with HCV who have developed cirrhosis and either portal hypertension or hepatic failure or both. We recommend that clinicians exercise caution when prescribing medications that can promote spontaneous bleeding to patients with multiple risk factors for internal hemorrhage.
选择性5-羟色胺再摄取抑制剂（SSRIs）越来越多地用于治疗接受丙型肝炎病毒（HCV）治疗患者的干扰素相关副作用。由于已发生肝硬化且伴有门静脉高压或肝衰竭或两者兼有的HCV感染患者出血风险增加，我们对有关SSRIs相关出血的文献进行了严格审查。
我们使用“出血”“SSRIs”和“抗抑郁药”作为检索词，对1966年至今的MEDLINE文献进行了检索，并追踪了相关引用文献。我们审查了6项回顾性研究，其中5项为病例对照研究，以及37例出血的18例病例报告。我们的综述补充了1例HCV感染男性中SSRI治疗与致命性胃肠道出血之间可能存在关联的病例报告。
18份报告中有12份（67%）描述了24人中有19人（79%）的出血事件与SSRIs的使用密切相关。
将阿司匹林或非甾体抗炎药与SSRIs联合用于治疗干扰素相关的神经精神副作用会增加已发生肝硬化且伴有门静脉高压或肝衰竭或两者兼有的HCV患者的出血风险。我们建议临床医生在给有多种内出血危险因素的患者开可促进自发性出血的药物时要谨慎。
