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Potential interactions between SSRIs and DOACs: population-based cohort and case-crossover study.

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Summary
This summary is machine-generated.

Concomitant use of direct oral anticoagulants (DOACs) and selective serotonin reuptake inhibitors (SSRIs) did not increase intracranial or gastrointestinal bleeding risk. However, initiating SSRIs while on DOACs may elevate other bleeding risks.

Keywords:
EpidemiologyHaematology

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Area of Science:

  • Pharmacovigilance
  • Clinical Epidemiology
  • Drug Safety

Background:

  • Direct oral anticoagulants (DOACs) and selective serotonin reuptake inhibitors (SSRIs) are associated with bleeding risks.
  • The combined effect of DOACs and SSRIs on bleeding risk is not well-established.

Purpose of the Study:

  • To investigate the bleeding hazard associated with the concurrent use of DOACs and SSRIs compared to DOACs with non-SSRI antidepressants.
  • To evaluate the risk of intracranial, gastrointestinal, and other bleeding events.

Main Methods:

  • A population-based cohort and case-crossover study utilizing UK primary care data (CPRD Aurum) from 2011 to 2021.
  • Propensity score weighting was used in the cohort design to compare DOAC+SSRI and DOAC+non-SSRI users.
  • A 6-parameter case-crossover design was employed to assess exposure patterns and bleeding outcomes, controlling for time-invariant confounding.

Main Results:

  • Cohort analysis showed no significant difference in intracranial, gastrointestinal, or other bleeding risks between DOAC+SSRI and DOAC+non-SSRI users.
  • Case-crossover analysis indicated a higher odds ratio for other bleeding events when initiating SSRIs while on DOACs (OR 1.64, 99% CI 1.14-2.35).
  • No increased risk of other bleeding was observed in DOAC users initiating non-SSRIs.

Conclusions:

  • Concomitant use of DOACs and SSRIs does not appear to elevate intracranial or gastrointestinal bleeding risks.
  • Initiating SSRIs during DOAC therapy may be associated with an increased risk of "other" bleeding events.
  • Further research into specific bleeding risks associated with combined DOAC and SSRI use is warranted.