Association of Type of Antidepressant Initiation with Bleeding Risk in Atrial Fibrillation Patients Taking Oral Anticoagulants.
Association of Type of Antidepressant Initiation with Bleeding Risk in Atrial Fibrillation Patients Taking Oral Anticoagulants.
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DOI：
10.1007/s40801-021-00258-3
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发表时间：
2021-09
影响因子：
--
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Shao IY;Claxton JS;Lutsey PL;Chen LY;MacLehose RF;Alonso A
不一致的证据表明，在使用口服抗凝剂(OAC)的患者中，使用某些抗抑郁药，特别是选择性5-羟色胺再摄取抑制剂(SSRIs)可能与出血风险增加有关。本研究旨在调查接受OAC治疗的房颤(AF)患者使用不同类型的抗抑郁药所致出血的风险。2007年至2015年期间，从Truven Health Analytics MarketScan商业和医疗保险数据库中确定了总共30,336名接受OAC治疗并开始抗抑郁治疗的房颤患者(平均年龄72.2岁；54%女性)。暴露定义为服用抗抑郁药，分类为SSRI、5-羟色胺/去甲肾上腺素再摄取抑制剂(SNRI)、5-羟色胺再摄取抑制剂(SRIs)、三环类抗抑郁药(TCA)或其他抗抑郁药。主要结果是意外住院出血。在两两倾向得分匹配的队列中，通过计算危险比(HR)和调整的COX模型的95%可信区间(CI)来评估抗抑郁药类型与出血的相关性。在平均21个月的随访中，我们确定了1612次出血事件。在成对比较中，与大多数其他抗抑郁药物相比，使用SSRI与出血风险增加相关(HR 1.22，95%CI 0.96-1.54 vs SNRI；HR 1.10，95%CI 0.90-1.35 vs SRI；HR 1.03，95%CI 0.82-1.30 vs TCA)。SNRI的使用与最低的出血风险相关。结果没有不同的OAC类型，年龄和性别。在服用OAC抗抑郁药的房颤患者中，出血的风险因抗抑郁药的类型而异。这一信息可以为接受OAC的患者的治疗选择提供信息。网上版载有补充材料，可在10.1007/s40801-021-00258-3查阅。
Inconsistent evidence suggests that use of certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), in patients using oral anticoagulants (OACs) 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. A total of 30,336 AF patients (mean age 72.2 years; 54% female) on OAC therapy that started antidepressant treatment were identified from the Truven Health Analytics MarketScan Commercial and Medicare Databases for the period 2007–2015. Exposure was defined as filling a prescription for antidepressant, and categorized as SSRI, serotonin/norepinephrine reuptake inhibitors (SNRIs), serotonin reuptake inhibitors (SRIs), tricyclic antidepressants (TCAs), or other antidepressants. The primary outcome was incident hospitalized bleeding. Associations of antidepressant type with bleeding were assessed calculating hazard ratios (HRs) and 95% confidence intervals (CIs) with adjusted Cox models in pairwise propensity score-matched cohorts. During a mean follow-up of 21 months, we identified 1612 bleeding episodes. In pairwise comparisons, SSRI use was associated with an increased risk of bleeding when compared to most other antidepressants (HR 1.22, 95% CI 0.96–1.54 vs SNRI; HR 1.10, 95% CI 0.90–1.35 vs SRI; HR 1.03, 95% CI 0.82–1.30 vs TCA). SNRI use was associated with the lowest bleeding risk. Results did not differ by OAC type, age, and sex. Among AF patients on OAC initiating antidepressants, risk of bleeding varied across antidepressant type. This information can inform treatment choices among patients receiving OAC. The online version contains supplementary material available at 10.1007/s40801-021-00258-3.
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DOI：
10.1136/bmj.d4551
发表时间：
2011-08-02
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Coupland C;Dhiman P;Morriss R;Arthur A;Barton G;Hippisley-Cox J
通讯作者：
Hippisley-Cox J
影响因子：
3.4
作者：
Ibanez, Luisa;Sabate, Monica;Gardarsdottir, Helga
通讯作者：
Gardarsdottir, Helga
影响因子：
2.5
作者：
Cochran, Kelly A.;Cavallari, Larisa H.;Bishop, Jeffrey R.
通讯作者：
Bishop, Jeffrey R.
影响因子：
24
作者：
Fang, Margaret C.;Go, Alan S.;Chang, Yuchiao;Borowsky, Leila H.;Pomernacki, Niela K.;Udaltsova, Natalia;Singer, Daniel E.
通讯作者：
Singer, Daniel E.
影响因子：
2.9
作者：
Abbing-Karahagopian, V.;Huerta, C.;De Bruin, M. L.
通讯作者：
De Bruin, M. L.