Antidepressant drug use and subdural hematoma risk

Garcı́a-Dorado, David; Rodrı́guez, Luis A. Garcı́a; Hald, Stine Munk; Hellfritzsch, Maja; Poulsen, Frantz Rom; Halle, Bo; Hallas, Jesper; Pottegård, Anton

doi:10.1111/jth.14658

Cited by 9 publications

(14 citation statements)

References 47 publications

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“…DNPR inpatient data with primary diagnostic position codes are frequently used in Danish studies of cerebrovascular disorders, as this approach is believed to result in outcomes with higher validity than data with broader criteria (eg, inclusion of inpatients regardless of diagnostic position of code). 4,6,[46][47][48][49][50] Our findings support this strategy with regard to s-ICH. We also note that the high sensitivity of s-ICH based on inpatient primary diagnostic position codes was stable in the 9-year study period and across agegroups.…”

Section: Discussionsupporting

confidence: 78%

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Hald¹,

Sloth²,

Agger³

et al. 2020

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Purpose: To establish the validity of intracerebral hemorrhage (ICH) diagnoses in the Danish Stroke Registry (DSR) and the Danish National Patient Registry (DNPR). Patients and Methods: Based on discharge summaries and brain imaging reports, we estimated the positive predictive value (PPV) of a first-ever diagnosis code for ICH (ICD-10, code I61) for all patients in the Region of Southern Denmark (1.2 million) during 2009-2017 according to either DNPR or DSR. We estimated PPVs for any non-traumatic ICH (a-ICH) and spontaneous ICH (s-ICH) alone (ie, without underlying structural cause). We also calculated the sensitivity of these diagnoses in each of the registers. Finally, we classified the location of verified s-ICH. Results: A total of 3,956 patients with ICH diagnosis codes were studied (DSR only: 87; DNPR only: 1,513; both registries: 2,356). In the DSR, the PPVs were 86.5% (95% CI=85.1-87.8) for a-ICH and 81.8% (95% CI=80.2-83.3) for s-ICH. The PPVs in DNPR (discharge code, primary diagnostic position) were 76.2% (95% CI=74.7-77.6) for a-ICH and 70.2% (95% CI=68.6-71.8) for s-ICH. Sensitivity for a-ICH and s-ICH was 76.4% (95% CI=74.8-78.0) and 78.7% (95% CI=77.1-80.2) in DSR, and 87.3% (95% CI=86.0-88.5) and 87.7% (95% CI=86.3-88.9) in DNPR. The location of verified s-ICH was lobar (39%), deep (33.6%), infratentorial (13.2%), large unclassifiable (11%), isolated intraventricular (1.9%), or unclassifiable due to insufficient information (1.3%). Conclusion: The validity of a-ICH diagnoses is high in both registries. For s-ICH, PPV was higher in DSR, while sensitivity was higher in DNPR. The location of s-ICH was similar to distributions seen in other populations.

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Section: Discussionsupporting

confidence: 78%

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Hald¹,

Sloth²,

Agger³

et al. 2020

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“…For secondary outcomes, the use of SRI among individuals treated with anticoagulant therapy revealed a higher risk of intracranial haemorrhage (10 studies [ 24 , 29 , 30 , 33–35 , 39–42 ]; n = 443,904; OR, 1.31; 95% CI, 1.02–1.68; p = .031; Figure 3(A) ), gastrointestinal bleeding (10 studies [ 24 , 29 , 33 , 34 , 36 , 43–47 ]; n = 1085014; OR, 1.34; 95% CI, 1.19–1.50; p < .001; Figure 4(A) ), and any bleeding events (23 studies [ 24–36 , 39–48 ]; n = 1,209,421; OR, 1.39; 95% CI, 1.24–1.55; p < .001; Figure 5(A) ). Likewise, use of SRI among individuals treated with antiplatelet agents also illustrated an increased risk of gastrointestinal bleeding (five studies [ 37 , 44 , 49–51 ]; n = 52571; OR, 1.30; 95% CI, 1.04–1.63; p = .021; Figure 4(B) ), any bleeding events (11 studies [ 37–40 , 42 , 44 , 49–53 ]; n = 153,790; OR, 1.15 (95% CI, 1.06–1.25; p = .001; Figure 5(B) ), except for intracranial haemorrhage (three studies [ 39 , 40 , 42 ]; n = 81173; OR, 1.08; 95% CI, 0.93–1.26; p = .325; Figure 3(B) ).…”

Section: Resultsmentioning

confidence: 99%

Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis

et al. 2021

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Background Serotonin reuptake inhibitor (SRI) antidepressants are implicated in increasing the risk of bleeding among users; however, the comparative increase in bleeding risk with concurrent antithrombotic therapy (anticoagulant or antiplatelet) remains unclear. As such, we performed a systematic review and meta-analysis of all available evidence to evaluate the effects of SRI and the risk of bleeding complications among patients receiving antithrombotic therapy. Methods We searched Medline, Embase, PubMed, PsycINFO, Cochrane Library, Web of Science, Scopus, CINAHL, and grey literature (Google Scholar and preprint reports) up to 26 November, 2020, with no language restrictions (updated on 31 July 2021). The primary outcome of interest was major bleeding. Secondary outcomes included intracranial haemorrhage, gastrointestinal bleeding, and any bleeding events. We used a random-effects model meta-analysis to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Results We did not identify any randomised studies but found 32 non-randomized studies (cohort or case–control) with 1,848,285 patients that fulfilled the study selection criteria and were included in the meta-analysis. Among individuals receiving anticoagulants (13 studies), SRI users experienced a statistically higher risk of major bleeding compared to non-SRI users: pooled OR was 1.39 (95% CI, 1.23–1.58; p < .001; moderate heterogeneity). Among individuals receiving antiplatelet therapy (2 studies), SRI users were associated with an increased risk of major bleeding: pooled OR was 1.45 (95% CI, 1.17–1.80; p = .001; low heterogeneity). For secondary outcomes, the use of SRI among individuals treated with antithrombotic therapy revealed a higher risk of gastrointestinal bleeding or any bleeding events, whereas only anticoagulant use was illustrated an increased risk of intracranial haemorrhage. Conclusions The use of SRI antidepressants among patients treated with antithrombotic therapy (either anticoagulant or antiplatelet) is associated with a higher risk of bleeding complications, suggesting that caution is warranted in co-prescription. PROSPERO Registration CRD42018083917 KEY MESSAGES In this meta-analysis of 32 non-randomized studies, SRI users were associated with the risk of bleeding complications compared to non-SRI users, with concurrent antithrombotic use (either anticoagulant or antiplatelet). The risk was consistently elevated across types of bleeding events (major bleeding, gastrointestinal bleeding, or any bleeding events), whereas only anticoagulant use was associated with intracranial haemorrhage. To promote the rational use of medicines, our findings suggest that the risk-benefit ratio must account for the clear efficacy of SRI against safety concern...

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“…After applying inclusion/exclusion criteria, 8 studies were included. [7][8][9][10][11][12][13][14] The main characteristics of the included studies are depicted in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Impact of Selective Serotonin-Reuptake Inhibitors in Hemorrhagic Risk in Anticoagulated Patients Taking Non–Vitamin K Antagonist Anticoagulants

Machado

Alves

Caldeira

2023

J Clin Psychopharmacol

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BackgroundStudies show an increase in hemorrhagic risk related to selective serotonin-reuptake inhibitors (SSRIs) alone, but also in association with vitamin K antagonists (VKAs). Non-VKA anticoagulants (NOACs) can be a good substitute to VKAs, but the correlation between them and SSRIs is not well studied. Therefore, we conducted a systematic review to evaluate the risk of major bleeding associated with concomitant use of SSRIs and NOACs.MethodsMEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PubMed databases were searched, in September 2022, for longitudinal studies evaluating SSRIs' impact on hemorrhagic risk in anticoagulated patients taking NOACs compared with a control group taking non-SSRI medication instead or no antidepressants at all. The outcome of interest was major bleeding. The quality of the included studies was assessed using the ROBINS-I tool. We performed a random-effects meta-analysis to estimate the pooled RRs with 95% confidence intervals (CIs), and heterogeneity was evaluated using the I2 statistic.ResultsEight studies were included in the meta-analysis. From a population of 279,540 anticoagulated patients taking NOACs, the ones taking SSRIs concomitantly were associated with a higher risk of major bleeding (relative risk, 1.33; 95% CI, 1.06–1.66; I2 = 60%). However, the subgroup analysis of cohort studies did not achieve statistical significance (relative risk, 1.05; 95% CI, 0.94–1.66).ConclusionsThe findings show that SSRIs are associated with a greater hemorrhagic risk in patients anticoagulated with NOACs; however, our confidence is reduced because of nonstatistically significant results from more robust studies, as cohort studies.

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Antidepressant drug use and subdural hematoma risk

Cited by 9 publications

References 47 publications

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis

Impact of Selective Serotonin-Reuptake Inhibitors in Hemorrhagic Risk in Anticoagulated Patients Taking Non–Vitamin K Antagonist Anticoagulants

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