Bleeding Incidence With Concomitant Use of Antidepressants and Warfarin
Bleeding Incidence With Concomitant Use of Antidepressants and Warfarin
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DOI：
10.1097/ftd.0b013e318224996e
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发表时间：
2011-08-01
影响因子：
2.5
通讯作者：
Bishop, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Cochran, Kelly A.;Cavallari, Larisa H.;Bishop, Jeffrey R.
简介：出血是华法林治疗的主要并发症。一些抗抑郁药还与出血风险增加有关。华法林和抗抑郁药经常联合使用，但目前尚不清楚联合使用是否会比单独使用华法林增加出血风险。本研究的主要目标是确定与单独使用华法林相比，使用华法林和抗抑郁药是否会增加出血结果的风险。第二个目标是确定服用特定类别抗抑郁药、选择性血清素再摄取抑制剂 (SSRI) 的华法林治疗患者的出血风险特征。 材料和方法：这是一项回顾性、单中心研究，研究对象为接受华法林治疗的患者（n = 46）和未服用（n = 54）抗抑郁药的患者。审查了 6 个月以上的医疗记录，以了解国际标准化比率值、病史、出血类型和发生率以及因出血而住院的情况。如果患者在 6 个月内持续同时服用华法林和抗抑郁药物，则被纳入抗抑郁药组；如果患者未同时服用华法林和抗抑郁药，则被纳入对照组。 结果：在 6 个月期间，使用任何抗抑郁药和华法林均与任何出血或大出血的发生率无关。然而，使用 SSRI 与华法林会增加任何出血事件的发生（比值比 2.6，95% 置信区间，1.01-6.4 P = 0.04）。在考虑了与出血风险相关的其他因素后，SSRIs 的使用仍然是出血的重要预测因素。结论：基于这些数据，考虑到华法林和 SSRIs 的高频率联合使用，澄清华法林和 SSRIs 之间在出血风险方面的相互作用非常重要。
Introduction: Bleeding is the major complication associated with warfarin therapy. Some antidepressants are also associated with increased bleeding risk. Warfarin and antidepressants are used frequently in combination, but it is unclear whether concomitant use increases the risk of bleeding beyond that with warfarin alone. The primary goal of this study was to determine whether the use of warfarin and an antidepressant increases the risk for bleeding outcomes compared with the use of warfarin alone. The secondary goal was to characterize the risk of bleeding in warfarin-treated patients taking one specific class of antidepressant, selective serotonin re-uptake inhibitors (SSRIs).Materials and Methods: This was a retrospective, single-center, study of warfarin-treated patients prescribed (n = 46) and not prescribed (n = 54) an antidepressant. Medical records over 6 months were reviewed for international normalized ratio values, medical history, bleeding type and incidence, and hospitalization due to bleeding. Patients were included in the antidepressant group if they were taking concomitant warfarin and antidepressant therapy consistently for a period of 6 months and in the control group if they were not taking an antidepressant with warfarin.Results: The use of any antidepressant with warfarin was not associated with the incidence of any bleeding or major bleeding during the 6-month period. However, the use of an SSRI with warfarin was associated with an increase in any bleeding event (odds ratio 2.6, 95% confidence interval, 1.01-6.4 P = 0.04). The use of an SSRI remained a significant predictor of bleeding after accounting for other factors associated with bleeding risk.Conclusions: Based on these data, it is important to clarify the interaction between warfarin and SSRIs in regard to bleeding risk given the high frequency of their concomitant use.