Abstract
ObjectivesNon‐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.MethodsPatients 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.ResultsData 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).ConclusionCo‐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.
Highlights
The increase in non‐vitamin K oral anticoagulant (NOAC) prescription has raised concern in clinical practice about safety and possible drug– drug interactions with other medication
The most frequent bleeding event was GI bleeding with 588 cases (59.6%), followed by cerebral haemorrhage with 344 (34.8%), and bleeding anaemia with 55 events (5.6%). (Table 1)
The risk of bleeding events was similar between selective serotonin reuptake inhibitor (SSRI) and other antidepressant medicine (ADTx) when combined with oral anticoagulants (p = 0.51)
Summary
The increase in non‐vitamin K oral anticoagulant (NOAC) prescription has raised concern in clinical practice about safety and possible drug– drug interactions with other medication. A strict laboratory monitoring is needed to ensure therapeutic efficacy of VKA. Over the past few years, apixaban, rivaroxaban, dabigatran, and edoxaban have been introduced as NOAC and offer several advantages over VKA.[1,2] These NOAC mitigate clot formation by interfering selectively with thrombin or factor Xa and have a rapid onset of therapeutic action, shorter half‐life, and predictable pharmacodynamic effects, and do not require routine laboratory monitoring compared with VKA. Drug–drug interactions need to be considered to avoid an increased bleeding risk.[3] There is evidence that SSRI may increase bleeding risks, when combined with VKA.[4] It is unknown if a similar risk is conferred by coadministration of NOAC with SSRI or other antidepressant medication
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