Antidepressants, warfarin, and the risk of hemorrhage
Antidepressants, warfarin, and the risk of hemorrhage
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DOI：
10.1097/01.jcp.0000186869.67418.bc
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发表时间：
2005-12-01
影响因子：
2.9
通讯作者：
Mamdani, MM
中科院分区：
文献类型：
--
作者：
Kurdyak, PA;Juurlink, DN;Mamdani, MM
背景：病例报告表明，一些选择性血清素再摄取抑制剂可以与华法林相互作用，增加出血的可能性。我们推测，在接受华法林的患者中，开始选择性血清素再摄取抑制剂治疗将与上消化道出血 (UGIB) 住院风险增加相关。 方法：我们进行了一项基于人群的巢式病例对照研究，涉及 66 岁或以上的安大略省居民，连续接受华法林治疗至少一年。将入院的 UGIB 病例与匹配对照（1:10）进行比较，探讨入院前 42、90 和 180 天内开始使用各种抗抑郁药物的比值比。 结果：从 1994 年 1 月到 2002 年 12 月，我们确定了 98,784 名连续接受华法林至少 1 年的老年患者；其中 1538 人（0.6%）因 UGIB 入院。 UGIB住院前90天内氟西汀/氟伏沙明暴露的调整后比值比为1.2（95%置信区间，0.8-1.7），同期其他选择性5-羟色胺再摄取抑制剂的调整比值比为1.1（95%置信区间，0.9-1.4）。 UGIB 住院前 180 天暴露于抗抑郁药物的比值比相似。结论：接受华法林的患者开始选择性血清素再摄取抑制剂治疗与 UGIB 住院风险显着增加无关。
Background: Case reports suggest that some selective serotonin reuptake inhibitors can interact with warfarin to increase the likelihood of bleeding. We speculated that, among patients receiving warfarin, initiation of selective serotonin reuptake inhibitor treatment would be associated with an increased risk of hospitalization for upper gastrointestinal tract bleeding (UGIB).Methods: We conducted a population-based, nested, case-control study involving Ontario residents 66 years or older continuously treated with warfarin for at least I year. Cases admitted with UGIB were compared with matched controls (1:10) to explore the odds ratio for initiation of various antidepressants within 42, 90, and 180 days before the index admission.Results: From January 1994 to December 2002, we identified 98,784 elderly patients continuously receiving warfarin for at least I year; of whom 1538 (0.6%) were admitted to hospital for UGIB. The adjusted odds ratio for fluoxetine/fluvoxamine exposure in 90 days before UGIB hospitalization is 1.2 (95% confidence interval, 0.8-1.7), and the adjusted odds ratio for other selective serotonin reuptake inhibitors in the same period was 1.1 (95% confidence interval, 0.9-1.4). The odds ratios for exposure to antidepressants in 180 days before UGIB hospitalization were similar.Conclusion: The initiation of selective serotonin reuptake inhibitor treatment in patients receiving warfarin was not associated with a significant increase in the risk of hospitalization for UGIB.