Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Healthcare Development, Stockholm County Council, Public Healthcare Services Committee, Stockholm, Sweden.
Clin Pharmacol Ther. 2020 Jan;107(1):287-294. doi: 10.1002/cpt.1603. Epub 2019 Sep 10.
We aimed to quantify the effects of antidepressant (AD) use in oral anticoagulant (OAC)-treated patients with atrial fibrillation (AF). Using the Stockholm Healthcare database, we analyzed AF patients initiated with an OAC. Outcomes were severe bleeds and strokes and were analyzed using Cox models. We included 17,210 patients claiming warfarin and 13,385 claiming a non-vitamin K OAC. The number of patients that claimed an AD during follow-up was 4,303. Concomitant OAC and AD use was associated with increased rates of severe bleeds (4.7 vs. 2.7 per 100 person-years) compared with OAC treatment alone (adjusted hazard ratio (aHR) 1.42, confidence interval (CI): 1.12-1.80), but not significantly associated with increased stroke rates (3.5 vs. 2.1 per 100 person-years, aHR 1.23, CI: 0.93-1.62). No significant differences in risks were observed between different OAC classes or different AD classes. In conclusion, concomitant use of an OAC and an AD is associated with an increased bleeding risk.
我们旨在定量评估在口服抗凝剂（OAC）治疗的心房颤动（AF）患者中使用抗抑郁药（AD）的效果。使用斯德哥尔摩医疗保健数据库，我们分析了开始使用 OAC 的 AF 患者。结果是严重出血和中风，并使用 Cox 模型进行了分析。我们纳入了 17210 名声称使用华法林的患者和 13385 名声称使用非维生素 K OAC 的患者。在随访期间声称使用 AD 的患者有 4303 名。与单独使用 OAC 治疗相比，同时使用 OAC 和 AD 治疗与严重出血发生率增加相关（每 100 人年 4.7 比 2.7，调整后的危险比（aHR）为 1.42，置信区间（CI）：1.12-1.80），但与中风发生率增加无显著相关性（每 100 人年 3.5 比 2.1，aHR 为 1.23，CI：0.93-1.62）。在不同的 OAC 类别或不同的 AD 类别之间，未观察到风险的显著差异。总之，OAC 和 AD 的同时使用与出血风险增加相关。
