a National Institute for Health Research Bristol Biomedical Research Centre , University Hospitals Bristol NHS Foundation Trust and University of Bristol , Bristol , UK.
b Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit , University of Bristol, Learning & Research Building (Level 1) , Southmead Hospital , Bristol , UK.
Ann Med. 2018 Sep;50(6):529-537. doi: 10.1080/07853890.2018.1500703. Epub 2018 Aug 25.
Evidence on the association between depression, antidepressant use and venous thromboembolism (VTE) risk is conflicting. We conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk.
Eligible studies were identified in a literature search of MEDLINE, Embase, Web of Science and reference list of relevant studies up to April 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were aggregated using random effects models.
Eight observational studies with data on 960 113 nonoverlapping participants and 9027 VTE cases were included. The pooled RR (95% CI) for VTE comparing antidepressant use with no antidepressant use was 1.27 (1.06-1.51). Tricyclic antidepressants, selective serotonin reuptake inhibitors and other antidepressants were each associated with an increased VTE risk; 1.16 (1.06-1.27), 1.12 (1.02-1.23), and 1.59 (1.21-2.09), respectively. In pooled analysis of three studies that compared patients with depression versus individuals without depression, the RR for VTE was 1.31 (1.13-1.53).
Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased VTE risk. The effect of antidepressant drugs on VTE may be a class effect. The mechanistic pathways underlying these associations deserve further evaluation. Systematic review registration: PROSPERO 2018: CRD42018095595 Key messages Emerging evidence suggests that depression and antidepressant use may be associated with venous thromboembolism (VTE) risk, but the evidence is conflicting. This first systematic review and meta-analysis of observational studies shows that depression and use of antidepressants are each associated with an increased risk of VTE. There may be a class effect of antidepressant drugs on VTE.
关于抑郁、抗抑郁药使用与静脉血栓栓塞症（VTE）风险之间的关联，证据相互矛盾。我们对评估抑郁和抗抑郁药使用与 VTE 风险关联的已发表观察性研究进行了系统回顾和荟萃分析。
在截至 2018 年 4 月的 MEDLINE、Embase、Web of Science 和相关研究参考文献中进行文献检索，确定符合条件的研究。使用随机效应模型汇总具有 95％置信区间（CI）的合并相对风险（RR）。
纳入了 8 项观察性研究，共涉及 960113 名无重叠参与者和 9027 例 VTE 病例的数据。与未使用抗抑郁药相比，使用抗抑郁药的 VTE 合并 RR（95％CI）为 1.27（1.06-1.51）。三环类抗抑郁药、选择性 5-羟色胺再摄取抑制剂和其他抗抑郁药与 VTE 风险增加相关；RR 分别为 1.16（1.06-1.27）、1.12（1.02-1.23）和 1.59（1.21-2.09）。在比较抑郁症患者与无抑郁症患者的三项研究的汇总分析中，VTE 的 RR 为 1.31（1.13-1.53）。
汇总的观察性证据表明，抑郁和抗抑郁药的使用均与 VTE 风险增加相关。抗抑郁药对 VTE 的影响可能是一种类效应。这些关联的潜在机制途径值得进一步评估。系统评价注册：PROSPERO 2018：CRD42018095595 主要发现 新出现的证据表明，抑郁和抗抑郁药的使用可能与静脉血栓栓塞症（VTE）风险相关，但证据相互矛盾。这是第一项针对观察性研究的系统回顾和荟萃分析显示，抑郁和抗抑郁药的使用均与 VTE 风险增加相关。抗抑郁药对 VTE 可能具有类效应。
