Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.
Thromb Haemost. 2023 Jan;123(1):54-63. doi: 10.1055/a-1932-8976. Epub 2022 Aug 29.
Selective serotonin reuptake inhibitors (SSRIs), the most prescribed antidepressants, are associated with a modestly increased risk of major bleeding. However, in patients treated with both SSRIs and oral anticoagulants (OACs), the risk of major bleeding may be substantial.
To assess the risk of major bleeding associated with concomitant use of SSRIs and OACs, compared with OAC use alone.
We searched MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (from inception to December 1, 2021) for clinical trials and observational studies assessing the association between concomitant use of SSRIs and OACs and the risk of major bleeding. Given sufficient homogeneity of studies, we conducted a random-effects meta-analysis to estimate a pooled hazard ratio (HR) of major bleeding associated with concomitant use of SSRIs and OACs, compared with OAC use alone.
The review comprised 14 studies, including 7 cohort and 7 nested case-control studies. Following assessment of clinical and methodological heterogeneity, eight studies with a total of 98,070 patients were eligible for the meta-analysis. The pooled HR of major bleeding associated with concomitant use of SSRIs and OACs was 1.35 (95% confidence interval [CI]: 1.14-1.58). In secondary analyses, the pooled HR for concomitant use of SSRIs and direct OACs was 1.47 (95% CI: 1.03-2.10).
Concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding. Overall, our findings suggest that physicians may need to tailor treatment according to individual patient risk factors for bleeding when prescribing SSRIs to patients using OACs.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是最常开的抗抑郁药，与大出血风险略有增加相关。然而，在同时使用 SSRIs 和口服抗凝剂（OACs）的患者中，大出血的风险可能相当大。
评估同时使用 SSRIs 和 OACs 与单独使用 OACs 相关的大出血风险。
我们检索了 MEDLINE、Embase、PsycINFO 和 Cochrane 对照试验中心注册库（从创建到 2021 年 12 月 1 日），以评估同时使用 SSRIs 和 OACs 与大出血风险之间的关联的临床试验和观察性研究。由于研究具有足够的同质性，我们进行了随机效应荟萃分析，以估计同时使用 SSRIs 和 OACs 与单独使用 OACs 相比，大出血的合并风险比（HR）。
该综述包括 14 项研究，包括 7 项队列研究和 7 项嵌套病例对照研究。在评估临床和方法学异质性后，有 8 项共纳入 98070 名患者的研究符合荟萃分析的条件。同时使用 SSRIs 和 OACs 与大出血相关的合并 HR 为 1.35（95%置信区间 [CI]：1.14-1.58）。在二次分析中，同时使用 SSRIs 和直接 OACs 的合并 HR 为 1.47（95% CI：1.03-2.10）。
同时使用 SSRIs 和 OACs 与大出血风险增加相关。总体而言，我们的研究结果表明，当给使用 OACs 的患者开 SSRIs 时，医生可能需要根据患者出血的个体风险因素来调整治疗方案。
