Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Columbia, MO, USA.
Ther Drug Monit. 2011 Aug;33(4):433-8. doi: 10.1097/FTD.0b013e318224996e.
Bleeding is the major complication associated with warfarin therapy. Some antidepressants are also associated with increased bleeding risk. Warfarin and antidepressants are used frequently in combination, but it is unclear whether concomitant use increases the risk of bleeding beyond that with warfarin alone. The primary goal of this study was to determine whether the use of warfarin and an antidepressant increases the risk for bleeding outcomes compared with the use of warfarin alone. The secondary goal was to characterize the risk of bleeding in warfarin-treated patients taking one specific class of antidepressant, selective serotonin reuptake inhibitors (SSRIs).
This was a retrospective, single-center, study of warfarin-treated patients prescribed (n = 46) and not prescribed (n = 54) an antidepressant. Medical records over 6 months were reviewed for international normalized ratio values, medical history, bleeding type and incidence, and hospitalization due to bleeding. Patients were included in the antidepressant group if they were taking concomitant warfarin and antidepressant therapy consistently for a period of 6 months and in the control group if they were not taking an antidepressant with warfarin.
The use of any antidepressant with warfarin was not associated with the incidence of any bleeding or major bleeding during the 6-month period. However, the use of an SSRI with warfarin was associated with an increase in any bleeding event (odds ratio 2.6, 95% confidence interval, 1.01-6.4 P = 0.04). The use of an SSRI remained a significant predictor of bleeding after accounting for other factors associated with bleeding risk.
Based on these data, it is important to clarify the interaction between warfarin and SSRIs in regard to bleeding risk given the high frequency of their concomitant use.
出血是华法林治疗相关的主要并发症。一些抗抑郁药也与出血风险增加有关。华法林和抗抑郁药经常联合使用，但尚不清楚联合使用是否会使出血风险超过单独使用华法林的风险。本研究的主要目的是确定与单独使用华法林相比，使用华法林和抗抑郁药是否会增加出血结局的风险。次要目标是描述使用华法林的患者中使用一种特定类型的抗抑郁药，即选择性 5-羟色胺再摄取抑制剂（SSRIs）的出血风险。
这是一项回顾性、单中心研究，研究对象为接受华法林治疗并开具（n = 46）和未开具（n = 54）抗抑郁药的患者。回顾了 6 个月的病历，记录国际标准化比值、病史、出血类型和发生率以及因出血住院的情况。如果患者在 6 个月内持续同时服用华法林和抗抑郁药，则将其纳入抗抑郁药组；如果未同时服用华法林和抗抑郁药，则将其纳入对照组。
在 6 个月期间，使用任何抗抑郁药与华法林联合治疗与任何出血或大出血的发生率无关。然而，与华法林合用 SSRI 与任何出血事件的发生率增加相关（比值比 2.6，95%置信区间 1.01-6.4，P = 0.04）。在校正其他与出血风险相关的因素后，使用 SSRI 仍然是出血的显著预测因素。
鉴于这些药物联合使用的频率很高，根据这些数据，阐明华法林和 SSRIs 之间在出血风险方面的相互作用非常重要。
