Document Detail

Bleeding incidence with concomitant use of antidepressants and warfarin.
MedLine Citation:
PMID:  21743381     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Bleeding is the major complication associated with warfarin therapy. Some antidepressants are also associated with increased bleeding risk. Warfarin and antidepressants are used frequently in combination, but it is unclear whether concomitant use increases the risk of bleeding beyond that with warfarin alone. The primary goal of this study was to determine whether the use of warfarin and an antidepressant increases the risk for bleeding outcomes compared with the use of warfarin alone. The secondary goal was to characterize the risk of bleeding in warfarin-treated patients taking one specific class of antidepressant, selective serotonin reuptake inhibitors (SSRIs).
MATERIALS AND METHODS: This was a retrospective, single-center, study of warfarin-treated patients prescribed (n = 46) and not prescribed (n = 54) an antidepressant. Medical records over 6 months were reviewed for international normalized ratio values, medical history, bleeding type and incidence, and hospitalization due to bleeding. Patients were included in the antidepressant group if they were taking concomitant warfarin and antidepressant therapy consistently for a period of 6 months and in the control group if they were not taking an antidepressant with warfarin.
RESULTS: The use of any antidepressant with warfarin was not associated with the incidence of any bleeding or major bleeding during the 6-month period. However, the use of an SSRI with warfarin was associated with an increase in any bleeding event (odds ratio 2.6, 95% confidence interval, 1.01-6.4 P = 0.04). The use of an SSRI remained a significant predictor of bleeding after accounting for other factors associated with bleeding risk.
CONCLUSIONS: Based on these data, it is important to clarify the interaction between warfarin and SSRIs in regard to bleeding risk given the high frequency of their concomitant use.
Kelly A Cochran; Larisa H Cavallari; Nancy L Shapiro; Jeffrey R Bishop
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Therapeutic drug monitoring     Volume:  33     ISSN:  1536-3694     ISO Abbreviation:  Ther Drug Monit     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-18     Completed Date:  2012-01-05     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  7909660     Medline TA:  Ther Drug Monit     Country:  United States    
Other Details:
Languages:  eng     Pagination:  433-8     Citation Subset:  IM    
Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Columbia, MO, USA.
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MeSH Terms
Anticoagulants / administration & dosage,  adverse effects
Antidepressive Agents / administration & dosage,  adverse effects*
Drug Synergism
Drug Therapy, Combination / methods
Hemorrhage / chemically induced*
International Normalized Ratio / methods
Middle Aged
Retrospective Studies
Risk Factors
Serotonin Uptake Inhibitors / administration & dosage,  therapeutic use
Warfarin / administration & dosage,  adverse effects*
Grant Support
Reg. No./Substance:
0/Anticoagulants; 0/Antidepressive Agents; 0/Serotonin Uptake Inhibitors; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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