Barbui Corrado, Andretta Margherita, De Vitis Giuseppe, Rossi Elisa, D'Arienzo Fabrizio, Mezzalira Luigi, De Rosa Marisa, Cipriani Andrea, Berti Alessandra, Nosè Michela, Tansella Michele, Bozzini Luigi
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, WHO Collaborating Centre for Research and Training in Mental Health, University of Verona, Italy. corrado.barbui@unoiv
J Clin Psychopharmacol. 2009 Feb;29(1):33-8. doi: 10.1097/JCP.0b013e3181929f7a.
This study assessed the risk of any bleeding abnormalities, including the risk of gastrointestinal bleeding, associated with antidepressant exposure. We used a case-control methodology. Case patients were individuals admitted with a diagnosis of abnormal bleeding. Control subjects were individuals admitted on the same date without evidence of abnormal bleeding. During the study period, 11,025 case patients were admitted for bleeding abnormalities (matched with 21,846 eligible control subjects), and 1008 were admitted for gastrointestinal bleeding (matched with 1990 eligible control subjects). With respect to any bleeding abnormalities, antidepressants as a group were not associated with an increased risk (adjusted odds ratio [OR], 0.99; 95% confidence interval [CI], 0.90-1.08). Similarly, selective serotonin reuptake inhibitors as a group, the group of tricyclic and related antidepressants, and the group of other antidepressants were not associated with an increased risk of bleeding. With respect to gastrointestinal bleeding abnormalities, antidepressants as a group were associated with a modestly increased risk (adjusted OR, 1.34; 95% CI, 1.01-1.80). Whereas the group of tricyclic and related antidepressants was not associated with an increased risk of bleeding, the group of selective serotonin reuptake inhibitors was associated with a nonsignificant trend toward an increased risk of bleeding (adjusted OR, 1.31; 95% CI, 0.91-1.88) and the group of other antidepressants with a statistically significant increase in the risk of bleeding (adjusted OR, 1.74; 95% CI, 1.04-2.93). In a population with a low baseline risk of bleeding, we detected a significant increase in the risk of gastrointestinal bleeding only.
本研究评估了与抗抑郁药暴露相关的任何出血异常风险，包括胃肠道出血风险。我们采用了病例对照方法。病例患者为被诊断有异常出血而入院的个体。对照受试者为同日入院但无异常出血证据的个体。在研究期间，11025例病例患者因出血异常入院（与21846例符合条件的对照受试者匹配），1008例因胃肠道出血入院（与1990例符合条件的对照受试者匹配）。就任何出血异常而言，抗抑郁药作为一个整体与风险增加无关（调整后的优势比[OR]为0.99；95%置信区间[CI]为0.90 - 1.08）。同样，选择性5-羟色胺再摄取抑制剂作为一个整体、三环及相关抗抑郁药组以及其他抗抑郁药组与出血风险增加均无关。就胃肠道出血异常而言，抗抑郁药作为一个整体与风险适度增加有关（调整后的OR为1.34；95%CI为1.01 - 1.80）。虽然三环及相关抗抑郁药组与出血风险增加无关，但选择性5-羟色胺再摄取抑制剂组有出血风险增加的非显著趋势（调整后的OR为1.31；95%CI为0.91 - 1.88），其他抗抑郁药组出血风险有统计学显著增加（调整后的OR为1.74；95%CI为1.04 - 2.93）。在出血基线风险较低的人群中，我们仅检测到胃肠道出血风险显著增加。
