Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Int J Geriatr Psychiatry. 2019 Aug;34(8):1194-1199. doi: 10.1002/gps.5117. Epub 2019 Apr 24.
Non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) are used for the prophylaxis and treatment of thromboembolic events. A potential drug-drug interaction and increased bleeding events have been reported with co-medication of selective serotonin receptor inhibitors (SSRIs) and VKA. The aim of this study was to investigate the bleeding risk of a coprescription of NOAC or VKA with SSRI.
Patients with prescription of NOAC or VKA and an antidepressant drug therapy (ADTx) were selected from the drug reimbursement database of 13 Austrian health insurance funds. For this cohort, hospital discharge diagnoses for gastrointestinal bleeding, cerebral haemorrhage, and bleeding anaemia between 2010 and 2015 were analysed.
Data were available from 50 196 female and 31 308 male patients. Among these, 892 patients had 987 hospitalisations with bleeding events. The most frequent bleeding cases were gastrointestinal bleedings with 588 events (59.6%), followed by cerebral haemorrhage with 344 (34.8%), and bleeding anaemia with 55 events (5.6%), respectively. The risk of bleeding events was similar between SSRI and other ADTx, when combined with oral anticoagulants (p = 0.51). Concomitant treatment of patients with SSRI or other ADTx and NOAC was associated with an increased bleeding risk compared with cotreatment with VKA (1.21, 95% CI: 1.05-1.40; p = 0.0097).
Co-medication of SSRI with VKA or NOAC has little if any impact on hospital discharge diagnoses for bleeding events compared with cotreatment of those anticoagulants with other antidepressant medications.
非维生素 K 口服抗凝剂（NOAC）或维生素 K 拮抗剂（VKA）用于预防和治疗血栓栓塞事件。据报道，与选择性 5-羟色胺再摄取抑制剂（SSRIs）和 VKA 联合用药时，会出现潜在的药物-药物相互作用和增加出血事件。本研究旨在调查 NOAC 或 VKA 与 SSRIs 联合用药的出血风险。
从 13 家奥地利健康保险公司的药物报销数据库中选择了同时使用 NOAC 或 VKA 和抗抑郁药物治疗（ADTx）的患者。对该队列在 2010 年至 2015 年间的胃肠道出血、脑出血和出血性贫血的住院诊断进行了分析。
共获得 50196 名女性和 31308 名男性患者的数据。其中 892 名患者发生 987 例出血事件。最常见的出血病例是胃肠道出血 588 例（59.6%），其次是脑出血 344 例（34.8%），出血性贫血 55 例（5.6%）。当与口服抗凝剂联合使用时，SSRIs 和其他 ADTx 的出血事件风险相似（p=0.51）。与 VKA 联合治疗相比，SSRIs 或其他 ADTx 与 NOAC 联合治疗的患者出血风险增加（1.21，95%CI：1.05-1.40；p=0.0097）。
与其他抗抑郁药物相比，SSRIs 与 VKA 或 NOAC 联合使用对出血事件的出院诊断几乎没有影响。
