Antidepressants and Risk of Upper Gastrointestinal Bleeding

Abajo, Francisco J. de; Montero, Dolores; Rodrı́guez, Luis A. Garcı́a; Madurga, Mariano

doi:10.1111/j.1742-7843.2006.pto_303.x

Cited by 81 publications

(54 citation statements)

References 38 publications

(45 reference statements)

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“…Pharmacodynamically, SSRIs could interact with acenocoumarol since the release of serotonin by platelets plays an important role in haemostasis [44,45]. This mechanism has not been clearly explained, but recent epidemiological data have demonstrated that SSRIs could significantly increase the risk of gastro-intestinal bleeding [46,47]. According to some studies, the use of SSRIs among the population treated with coumarins seems to place patients at an increased risk of bleeding [15,48,49].…”

Section: Discussionmentioning

confidence: 99%

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Gschwind

Rollason

Lovis

et al. 2012

Eur J Clin Pharmacol

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Purpose The objective of this study was to identify the most clinically relevant drug-drug interactions (DDIs) at risk of affecting acenocoumarol safety in our tertiary care university hospital, a 2,000 bed institution. Methods We identified DDIs occurring with acenocoumarol by combining two different sources of information: a 1-year retrospective analysis of acenocoumarol prescriptions and comedications from our Computerized Physician Order Entry (CPOE) system (n = 2,439 hospitalizations) and a retrospective study of clinical pharmacology consultations involving acenocoumarol over the past 14 years (1994-2007) (n = 407). We classified these DDIs using an original risk-analysis method. A criticality index was calculated for each associated drug by multiplying three scores based on mechanism of interaction, involvement in a supratherapeutic international normalized ratio (INR) (≥ 6) and involvement in a severe bleeding.Results One hundred and twenty-six DDIs were identified and weighted. Twenty-eight drugs had a criticality index ≥ 20 and were therefore considered at high risk for interacting with acenocoumarol by increasing its effect: 75% of these drugs involved a pharmacokinetic mechanism and 14 % a pharmacodynamic mechanism. An unknown mechanism of interaction was involved in 11 % of drugs. Conclusion Twenty-eight specific drugs were identified as being at high risk for interacting with acenocoumarol in our hospital using an original risk-analysis method. Most analyzed drugs interact with acenocoumarol via a pharmacokinetic mechanism. Actions such as the implementation of alerts in our CPOE system should be specifically developed for these drugs.

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Section: Discussionmentioning

confidence: 99%

Identification and weighting of the most critical “real-life” drug–drug interactions with acenocoumarol in a tertiary care hospital

Gschwind

Rollason

Lovis

et al. 2012

Eur J Clin Pharmacol

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“…hemoptizi, 2 peteşi, 3 ekimoz, 4 subkonjuktival kanama, 5 üst gastrointestinal kanama, 6,7 perioperatif kanama, 7 vajinal kanama, 4 postpartum kanama 8 ve hematüri 2 şeklinde kanama bozukluklarına neden olduklarını gösteren birçok çalış-ma ve olgu bildirimi vardır. Ekimoz şeklinde ortaya çıkan kanama bozuklukları sertralin, 4 fluoksetin, 9 paroksetin 10 ve fluvoksamin 11 kullanımı sonrasında bildirilmiştir.…”

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Dose-dependent spontaneous ecchymotic lesions after use of escitalopram: a case report

Vardar¹,

Tezcan²,

Belli³

et al. 2017

Anadolu Psikiyatri Derg

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“…It has been estimated that upper gastrointestinal bleeding occurs at 1 in 100 to 1 in 1,000 patient-years of exposure to high-affinity drugs (the SSRIs), with the very old patients being at the highest risk. The increased risk may be of particular relevance when the SSRIs are associated with nonsteroidal anti-inflammatory drugs (NSAIDs), as well as low-dose aspirin 1 . Bleeding from the upper gastrointestinal tract, caused by the SSRIs may appear through the SSRI induced inhibition of serotonin reuptake from platelets, leading to platelet serotonin depletion after several weeks of treatment.…”

Section: Introductionmentioning

confidence: 99%