gms | German Medical Science

Background: Non-vitamin K oral anticoagulants (NOAC) or vitamin-K antagonists (VKA) are used for the prophylaxis and treatment of thromboembolic events. The increase in NOAC prescription has raised concern in clinical practice about safety and possible drug-drug interactions with other medication. A potential drug-drug interaction and increased bleeding events have been reported with co-medication of selective serotonin receptor inhibitors (SSRI) and VKA. The aim of this study was to investigate the bleeding risk of a co-prescription of NOAC or VKA with SSRI.

Materials and methods: Patients with prescription of NOAC or VKA and an antidepressant drug therapy (ADTx) were selected from the drug reimbursement database of 13 Austrian health insurance funds. Prescription and demographic data and hospital discharge diagnoses for myocardial infarction, gastrointestinal (GI-) bleeding, cerebral haemorrhage, and bleeding anaemia between 2010 and 2015 were analysed.

Results: Data were available from 50196 female and 31308 male patients. Among these, 892 patients had 987 hospitalisations with bleeding events. The most frequent bleeding cases were GI-bleedings with 588 events (59.6%), followed by cerebral haemorrhage with 344 (34.8%), and bleeding anaemia with 55 events (5.6%), respectively. The risk of bleeding events was similar between SSRI and other ADTx, when combined with oral anticoagulants (p=0.51). Concomitant treatment of patients with SSRI or other ADTx and NOAC was associated with an increased bleeding risk compared to co-treatment with VKA (1.21, 95 % CI 1.05-1.40; p=0.0097).

Conclusion: Co-medication of SSRI with VKA or NOAC has little if any impact on hospital discharge diagnoses for bleeding events compared to co-treatment of those anticoagulants with other antidepressant medications.