Risk for Major Bleeding with Concomitant Use of SSRIs and Oral Anticoagulants in Patients with Atrial Fibrillation

Selective serotonin reuptake inhibitors (SSRIs) inhibit platelet uptake of serotonin, which is one of many promoters of platelet aggregation. Many (but not all) studies in the past 15 years have shown that risk for major bleeding is higher with concomitant use of SSRIs and oral anticoagulants than with oral anticoagulants alone. Investigators used a U.K. general practice database to conduct a case–control study that involved 42,000 patients with atrial fibrillation who were prescribed oral anticoagulants and then had major bleeding events (i.e., hospitalization or death) and >1 million controls.

During a mean follow-up of nearly 5 years, incidence of major bleeding with oral anticoagulants was about 28 per 1000 person-years. Adjusted relativ…