Intracranial haemorrhage and use of selective serotonin reuptake inhibitors
Intracranial haemorrhage and use of selective serotonin reuptake inhibitors
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DOI：
10.1046/j.1365-2125.2000.00216.x
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发表时间：
2000-07-01
影响因子：
3.4
通讯作者：
Schmitz, S
中科院分区：
文献类型：
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作者：
de Abajo, FJ;Jick, H;Schmitz, S
在过去的几年中，越来越多的出血性疾病的报告与使用选择性5-羟色胺再摄取抑制剂（SSRIs），包括颅内出血的严重病例，引起了人们对这类药物的安全性的关注。本研究进行测试的假设与使用SSRIs.Methods颅内出血的风险增加，我们进行了一项病例对照研究嵌套在一个队列的抗抑郁药用户与英国的全科医学研究数据库（GPRD）作为主要信息来源。研究队列包括1990年1月至1997年10月期间首次接受任何抗抑郁药处方的18 - 79岁受试者。存在可能与颅内出血风险增加相关的疾病或治疗的患者从队列中排除。对患者进行随访，直至发生特发性颅内出血。从研究队列中随机选择年龄、性别、日历时间和实践相匹配的每个病例最多4个对照。我们估计调整后的比值比和95%的置信区间颅内出血与目前使用的SSRIs和其他抗抑郁药相比，非使用条件logistic regression.Results，我们确定了65例特发性颅内出血和254匹配的控制。在7例病例（10.8%）和24例对照（9.7%）中确定了当前SSRIs暴露，调整后OR（95%CI）为0.8（0.3，2.3）。“其他抗抑郁药”的估计值为0.7（0.3，1.6）。未按性别或年龄修改效应指标。未检测到与剂量或治疗持续时间相关的影响。根据出血的位置（脑内或蛛网膜下腔）的风险估计并没有改变。结论我们的研究结果是不兼容的SSRIs或其他抗抑郁药的用户之间的颅内出血的风险增加。然而，不能排除较小但仍相关的风险增加。
Aims In the past few years an increasing number of bleeding disorders have been reported in association with the use of selective serotonin reuptake inhibitors (SSRIs), including serious cases of intracranial haemorrhage, raising concerns about the safety of this class of drugs. The present study was performed to test the hypothesis of an increased risk of intracranial haemorrhage associated with the use of SSRIs.Methods We carried out a case-control study nested in a cohort of antidepressants users with the UK-based General Practice Research Database (GPRD) as the primary source of information. The study cohort encompassed subjects aged between 18 and 79 years who received a first-time prescription for any antidepressant from January, 1990 to October, 1997. Patients with presenting conditions or treatments that could be associated with an increased risk of intracranial haemorrhage were excluded from the cohort. Patients were followed-up until the occurrence of an idiopathic intracranial haemorrhage. Up to four controls per case, matched on age, sex, calendar time and practice were randomly selected from the study cohort. We estimated adjusted odds ratios and 95% confidence intervals of intracranial haemorrhage with current use of SSRIs and other antidepressants as compared with nonuse using conditional logistic regression.Results We identified 65 cases of idiopathic intracranial haemorrhage and 254 matched controls. Current exposure to SSRIs was ascertained in 7 cases (10.8%) and 24 controls (9.7%) resulting in an adjusted OR (95%CI) of 0.8 (0.3,2.3). The estimate for 'other antidepressants' was 0.7 (0.3,1.6). The effect measures were not modified by gender or age. No effect related to dose or treatment duration was detected. The risk estimates did not change according to the location of bleeding (intracerebral or subarachnoid).Conclusions Our results are not compatible with a major increased risk of intracranial haemorrhage among users of SSRIs or other antidepressants at large. However, smaller but still relevant increased risks cannot be ruled out.