Abstract
Background: Inconsistent evidence suggests that concomitant use of certain antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), in patients using oral anticoagulants (OAC) might be associated with an elevated risk of bleeding. This study aims to investigate the risk of bleeding associated with initiation of different types of antidepressants among atrial fibrillation (AF) patients on OAC therapy. Methods: 72334 AF patients that started using antidepressant after initiating OAC therapy were identified from the Truven Health MarketScan Commercial and Medicare Databases for the period 2011-2015. Exposure was defined as prescription filling for SSRI, Serotonin/Norepinephrine Reuptake Inhibitors (SNRI), Serotonin Reuptake Inhibitors (SRI), Tricyclic Antidepressants (TCA) or other antidepressants. The primary outcome was incident hospitalized bleeding, defined by a validated algorithm, after antidepressant initiation. Associations of bleeding by antidepressant types were assessed using adjusted Cox proportional hazards model in pair-wise propensity score (PS) matched cohorts. PS matched cohorts for combinations of antidepressants were generated based on logistic models that included major risk factors for bleeding such as demographic information, comorbid conditions and other medication usage. Results: Among eligible patients, 57% initiated SSRI, 14% SNRI, 9% SRI, 9% TCA and 12% others. During a mean follow-up of 21 months, we identified 4035 bleeding episodes. In pair-wise comparisons, SSRI was associated with an increased risk of bleeding when compared to all other antidepressants (Table 1). In contrast, initiating SRIs was associated with small reductions in the risk of bleeding compared to all other types of antidepressants. Conclusion: Our results suggest that compared to all other antidepressants, SSRI is associated with an increased risk of bleeding. This information may be valuable to inform antidepressant choice in anticoagulated patients with AF.
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