Antidepressants, antiplatelets and bleeding: One more thing to worry about?

Juurlink, David N.

doi:10.1503/cmaj.111576

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…It is unclear whether the increased risk of VTE we observed in women taking antidepressants reflects a pharmacological effect or some other factor associated with depression or anxiety, as an excess risk was observed for chemically diverse classes of antidepressants including SSRIs which have been reported to inhibit platelet function 34. We were able to explore potential confounding by a number of major risk factors for VTE, including comorbidities such as inflammatory bowel disease, although we did not have information about factors such as thrombophilia and family history.…”

Section: Discussionmentioning

confidence: 98%

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Parkin

Balkwill

Sweetland

et al. 2017

JAHA

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BackgroundSome investigators have reported an excess risk of venous thromboembolism (VTE) associated with depression and with use of antidepressant drugs. We explored these associations in a large prospective study of UK women.Methods and ResultsThe Million Women Study recruited 1.3 million women through the National Health Service Breast Screening Programme in England and Scotland. Three years after recruitment, women were sent a second questionnaire that enquired about depression and regular use of medications in the previous 4 weeks. The present analysis included those who responded and did not have prior VTE, cancer, or recent surgery. Follow‐up for VTE was through linkage to routinely collected National Health Service statistics. Cox regression analyses yielded adjusted hazard ratios and 95% CIs. A total of 734 092 women (mean age 59.9 years) were included in the analysis; 6.9% reported use of antidepressants, 2.7% reported use of other psychotropic drugs, and 1.8% reported being treated for depression or anxiety but not use of psychotropic drugs. During follow‐up for an average of 7.3 years, 3922 women were hospitalized for and/or died from VTE. Women who reported antidepressant use had a significantly higher risk of VTE than women who reported neither depression nor use of psychotropic drugs (hazard ratio, 1.39; 95% CI, 1.23–1.56). VTE risk was not significantly increased in women who reported being treated for depression or anxiety but no use of antidepressants or other psychotropic drugs (hazard ratio, 1.19; 95% CI, 0.95–1.49).ConclusionsUse of antidepressants is common in UK women and is associated with an increased risk of VTE.

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Section: Discussionmentioning

confidence: 98%

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Parkin

Balkwill

Sweetland

et al. 2017

JAHA

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“…We had the most extensive list of co-medications that could add additional risk to bleeding from SRI exposure. Bleeding may be more likely to occur if antidepressants are taken concurrently with non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants, or antiplatelet agents because the mechanism of anticoagulation for antidepressants is different than for each of these medications, which results in additive risk (Andrade et al, 2010, Juurlink, 2011). To examine this possibility we conducted an additional analysis where women who were on an SRI and a medication associated with bleeding, but otherwise met inclusion criteria for this analysis, were included.…”

Section: Discussionmentioning

confidence: 99%

Is third trimester serotonin reuptake inhibitor use associated with postpartum hemorrhage?

Kim

Pinheiro

Luther

et al. 2016

Journal of Psychiatric Research

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As serotonin reuptake inhibitor (SRI) use may decrease platelet function, previous research has shown a relationship between SRI use and an increased risk for bruising and bleeding. The literature regarding the association between SRI use during pregnancy and increased bleeding at delivery, referred to as postpartum hemorrhage (PPH), is mixed. In secondary analyses from two prospective observational studies of pregnant women with mood disorders, 263 women were exposed to an SRI (n=51) or not (n=212) in the third trimester. To be precise, we used the terminology estimated blood loss (EBL) > 600 cc rather than the term PPH because the current definition of PPH differs. The occurrence of EBL > 600 cc was determined using the Peripartum Events Scale (PES) completed from obstetrical records by a blinded medically trained member of the study team. EBL > 600 cc occurred in 8.7% of women in this cohort. There was no statistically significant difference in the rates of EBL > 600 cc in the 24 hours after delivery in women taking SRIs during the third trimester (9.8%) compared to non-exposed women (8.5%). Utilizing generalizing estimating equations, the odds of EBL > 600 cc in each group were not significantly different (OR 1.17, CI-0.41-3.32, p=0.77). When the SRI group was limited to women with exposure at the time of delivery, the difference in the odds of EBL > 600 cc was unchanged (OR 1.16, CI=0.37-3.64, p=0.79). In population, both third trimester and use at delivery of SRIs during pregnancy was not associated with an increased risk of excessive blood loss.

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“…Aspirin is another important prescription medication for treating and preventing ischemic stroke and TIA. In theory, SSRI and SNRI reuptake serotonin in platelets as well as they do in the central nervous system, which reduce platelet serotonin and may be associated with aspirin-related bleeding[ 50 ].…”

Section: Depressive Disorders After Strokementioning

confidence: 99%

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

Zhang¹,

Xu²,

Liu³

et al. 2020

WJP

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A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.

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Antidepressants, antiplatelets and bleeding: One more thing to worry about?

Cited by 6 publications

References 15 publications

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Antidepressants, Depression, and Venous Thromboembolism Risk: Large Prospective Study of UK Women

Is third trimester serotonin reuptake inhibitor use associated with postpartum hemorrhage?

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

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