1. 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
- Author
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Surapon Nochaiwong, Chidchanok Ruengorn, Ratanaporn Awiphan, Chatree Chai-Adisaksopha, Apichat Tantraworasin, Chabaphai Phosuya, Penkarn Kanjanarat, Wilaiwan Chongruksut, Manish M. Sood, and Kednapa Thavorn
- Subjects
antidepressant ,Anticoagulants ,Hemorrhage ,General Medicine ,antiplatelet ,bleeding complications ,serotonin-reuptake inhibitors ,Antidepressive Agents ,meta-analysis ,Anticoagulation ,Medicine ,Humans ,Cardiology & Cardiovascular Disorders ,Platelet Aggregation Inhibitors ,Selective Serotonin Reuptake Inhibitors ,Research Article - Abstract
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
- Published
- 2021