Clinical Edge

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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.


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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