Document Detail

Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction.
MedLine Citation:
PMID:  21948719     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients prescribed antiplatelet treatment to prevent recurrent acute myocardial infarction are often also given a selective serotonin reuptake inhibitor (SSRI) to treat coexisting depression. Use of either treatment may increase the risk of bleeding. We assessed the risk of bleeding among patients taking both medications following acute myocardial infarction.
METHODS: We conducted a retrospective cohort study using hospital discharge abstracts, physician billing information, medication reimbursement claims and demographic data from provincial health services administrative databases. We included patients 50 years of age or older who were discharged from hospital with antiplatelet therapy following acute myocardial infarction between January 1998 and March 2007. Patients were followed until admission to hospital due to a bleeding episode, admission to hospital due to recurrent acute myocardial infarction, death or the end of the study period.
RESULTS: The 27,058 patients in the cohort received the following medications at discharge: acetylsalicylic acid (ASA) (n = 14,426); clopidogrel (n = 2467), ASA and clopidogrel (n = 9475); ASA and an SSRI (n = 406); ASA, clopidogrel and an SSRI (n = 239); or clopidogrel and an SSRI (n = 45). Compared with ASA use alone, the combined use of an SSRI with antiplatelet therapy was associated with an increased risk of bleeding (ASA and SSRI: hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.08-1.87; ASA, clopidogrel and SSRI: HR 2.35, 95% CI 1.61-3.42). Compared with dual antiplatelet therapy alone (ASA and clopidogrel), combined use of an SSRI and dual antiplatelet therapy was associated with an increased risk of bleeding (HR 1.57, 95% CI 1.07-2.32).
INTERPRETATION: Patients taking an SSRI together with ASA or dual antiplatelet therapy following acute myocardial infarction were at increased risk of bleeding.
Christopher Labos; Kaberi Dasgupta; Hacene Nedjar; Gustavo Turecki; Elham Rahme
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-09-26
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  183     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-08     Completed Date:  2011-12-29     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1835-43     Citation Subset:  AIM; IM    
Department of Medicine, McGill University, Montréal, Que.
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MeSH Terms
Adrenal Cortex Hormones / therapeutic use
Age Factors
Anemia / epidemiology
Anticoagulants / therapeutic use
Antihypertensive Agents / therapeutic use
Aspirin / administration & dosage,  adverse effects
Canada / epidemiology
Citalopram / administration & dosage,  adverse effects
Cohort Studies
Drug Therapy, Combination
Fluoxetine / administration & dosage,  adverse effects
Fluvoxamine / administration & dosage,  adverse effects
Heart Failure / epidemiology
Hemorrhage / chemically induced*,  epidemiology
Hypoglycemic Agents / therapeutic use
Middle Aged
Myocardial Infarction / prevention & control*
Neoplasms / epidemiology
Paroxetine / administration & dosage,  adverse effects
Peptic Ulcer / epidemiology
Platelet Aggregation Inhibitors / administration & dosage,  adverse effects*
Recurrence / prevention & control
Renal Insufficiency / epidemiology
Retrospective Studies
Risk Factors
Serotonin Uptake Inhibitors / administration & dosage,  adverse effects*
Sertraline / administration & dosage,  adverse effects
Sex Factors
Ticlopidine / administration & dosage,  adverse effects,  analogs & derivatives
Grant Support
//Canadian Institutes of Health Research
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anticoagulants; 0/Antihypertensive Agents; 0/Hypoglycemic Agents; 0/Platelet Aggregation Inhibitors; 0/Serotonin Uptake Inhibitors; 50-78-2/Aspirin; 54739-18-3/Fluvoxamine; 54910-89-3/Fluoxetine; 55142-85-3/Ticlopidine; 59729-33-8/Citalopram; 61869-08-7/Paroxetine; 79617-96-2/Sertraline; A74586SNO7/clopidogrel
Comment In:
CMAJ. 2011 Nov 8;183(16):1819-20   [PMID:  21969407 ]

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