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Clinical Management of Bleeding Risk With Antidepressants

Alexandra L Bixby1, Amy VandenBerg1, Jolene R Bostwick2

  • 11 Michigan Medicine, Ann Arbor, MI, USA.

The Annals of Pharmacotherapy
|August 8, 2018
PubMed

Insights

Serotonin reuptake inhibitors (SRIs) significantly increase bleeding risk, especially when combined with NSAIDs. Alternative antidepressants may be suitable for high-risk patients.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Patient Safety

Background:

  • Serotonin reuptake inhibitors (SRIs) are widely prescribed antidepressants.
  • Understanding the bleeding risk associated with SRIs is crucial for patient safety.
  • Concurrent use of SRIs with other medications can modify bleeding risk.

Purpose of the Study:

  • To review the risk of bleeding associated with serotonin reuptake inhibitors (SRIs).
  • To provide evidence-based recommendations for managing patients at risk of bleeding while on SRI treatment.
  • To identify factors that influence bleeding risk in SRI users.

Main Methods:

  • A nonsystematic review of English-language MEDLINE articles published before June 2018.
  • Searches included terms related to SRIs, antidepressants, hemorrhage, and stroke.
  • Meta-analyses and individual studies were used to assess bleeding risk with specific SRIs and concomitant medications.

Main Results:

  • SRIs increase bleeding risk by 1.16- to 2.36-fold.
  • Concomitant use of SRIs and NSAIDs shows synergistic bleeding risk (OR 3.17-10.9).
  • Acid-reducing agents may reduce gastrointestinal bleeds in users of NSAIDs and SRIs.

Conclusions:

  • Clinicians must recognize the increased bleeding risk with SRIs, particularly when co-prescribed with NSAIDs.
  • Patient education regarding concurrent NSAID and SRI use is essential.
  • Alternative antidepressants with lower serotonin transporter affinity may be considered for high-risk individuals.
Abstract

Keywords:
anticoagulationantidepressantsantiplateletsnonsteroidal anti-inflammatory drugsproton pump inhibitorsserotonin

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