Antidepressant Drug Prescription and Risk of Abnormal Bleeding

Abstract

This study assessed the risk of any bleeding abnormalities, including the risk of gastrointestinal bleeding, associated with antidepressant exposure. We used a case-control methodology. Case patients were individuals admitted with a diagnosis of abnormal bleeding. Control subjects were individuals admitted on the same date without evidence of abnormal bleeding. During the study period, 11,025 case patients were admitted for bleeding abnormalities (matched with 21,846 eligible control subjects), and 1008 were admitted for gastrointestinal bleeding (matched with 1990 eligible control subjects). With respect to any bleeding abnormalities, antidepressants as a group were not associated with an increased risk (adjusted odds ratio [OR], 0.99; 95% confidence interval [CI], 0.90-1.08). Similarly, selective serotonin reuptake inhibitors as a group, the group of tricyclic and related antidepressants, and the group of other antidepressants were not associated with an increased risk of bleeding. With respect to gastrointestinal bleeding abnormalities, antidepressants as a group were associated with a modestly increased risk (adjusted OR, 1.34; 95% CI, 1.01-1.80). Whereas the group of tricyclic and related antidepressants was not associated with an increased risk of bleeding, the group of selective serotonin reuptake inhibitors was associated with a nonsignificant trend toward an increased risk of bleeding (adjusted OR, 1.31; 95% CI, 0.91-1.88) and the group of other antidepressants with a statistically significant increase in the risk of bleeding (adjusted OR, 1.74; 95% CI, 1.04-2.93). In a population with a low baseline risk of bleeding, we detected a significant increase in the risk of gastrointestinal bleeding only.

A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database

“…160 In the absence of trials of sufficient size to identify differences in rare adverse outcomes, studies examining associations between antidepressant use and GI bleeding have been largely confined to cohort studies [24][25][26] and case-control studies. 27,[161][162][163] Whereas some studies have found an increased risk of GI bleeds to be associated with antidepressant use, 24,27,161 others have found no evidence for an effect. 25,163 There is conflicting evidence as to whether 25,26,162 or not 27 that risk is increased in the presence of NSAID use.…”

“…Among adults admitted to hospital, a modest increased risk of GI bleeding was found with antidepressant use, but this was restricted to the group of other antidepressant drugs rather than TCAs or SSRIs. 161 A case-control study found that SSRIs overall were associated with an increased risk of upper GI tract bleeding, and also found a particularly increased risk for venlafaxine. 162 In a study of medication data, combined use of SSRIs and NSAIDs strongly increased the risk of GI adverse effects.…”

Antidepressants and the risk of abnormal bleeding during spinal surgery: a case–control study

“…Barbui et al in a case-control study also found a modestly increased risk of gastrointestinal (GI) bleeding with usage of SSRIs, but no increased risk with tricyclic antidepressants. They showed that other antidepressants (including mianserin, trazodone, and venlafaxine) were associated with a statistically significant increased risk of GI bleeding [11]. Elderly patients are at greater risk for bleeding sequelae [5], as well as those who take agents with a higher degree of serotonin reuptake inhibition [12,13] ( Tables 5, 6).…”

The Effect of Sibutramine, a Serotonin-Norepinephrine Reuptake Inhibitor, on Platelets and Fibrin Networks of Male Sprague-Dawley Rats: A Descriptive Study

“…Several studies have reported bleeding complications associated with the use of Selective Serotonin Reuptake Inhibitors (SSRIs) [13][14][15][16]. In contrast, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) with a similar mechanism of action as sibutramine, generally are not associated with increased bleeding risks.…”