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SSRIs & Bleeding Risk in AF Patients Taking Anticoagulants

J Am Heart Assoc; ePub 2018 Jul 27; Quinn, et al

When selective serotonin reuptake inhibitors (SSRIs) were combined with anticoagulant therapy, no significant increase in bleeding risk was found. However, there was a suggestion of increased bleeding risk with SSRIs added to warfarin. This according to a recent analysis from the ROCKET AF Trial in which researchers studied 737 patients taking SSRIs for the prevention of stroke/systemic embolism in those with atrial fibrillation (AF). Patients were propensity score matched 1:1 to 737 patients not taking SSRIs. The primary outcome measure was major and nonmajor clinically relevant bleeding events. They found:

  • Over a mean follow-up of 1.6 years, the rate of major/nonmajor clinically relevant bleeding was 18.57 events/100 patients years for SSRI users vs 16.84 events/100 patient-years for matched comparators (adjusted hazard ratio [aHR] 1.16).
  • The aHRs were similar in patients taking rivaroxaban and those taking warfarin (1.11 vs 1.21, respectively).
  • For the rarer outcome of major bleeding, the aHR was higher for warfarin (1.58), but not statistically significantly elevated.

Citation:

Quinn GR, Hellkamp AS, Hankey GJ, et al. Selective serotonin reuptake inhibitors and bleeding risk in anticoagulated patients with atrial fibrillation: An analysis from the ROCKET AF Trial. [Published online ahead of print July 27, 2018]. J Am Heart Assoc. doi:10.1161/JAHA.118.008755.

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