What are the risks of combining antidepressant therapy in a patient on anticoagulants for prevention of stroke secondary to atrial fibrillation?
1. Bleeding. Concomitant use of antidepressants and anticoagulants increased the rate of severe bleeds from 4.7 vs. 2.7 100-person years compared to anticoagulation alone. 2. Stroke. Concomitant use of antidepressants and anticoagulants was associated with an increased, though not statistically signficant, increase in stroke from 3.5 vs 2.1 per 100 person years. (Komen JJ, Hjerndahl P, Mantel-Teeuwisse AK, Klungel OH, Wettermark B, Forslund T. Concomitant Anticoagulant and Antidepressant Therapy in Atrial Fibrillation Patients and Risk of Stroke and Bleeding. Clinical Pharmacology & Therapeutics 2019;107(1): https://doi.org/10.1002/cpt.1603 This was a Swedish study using the Stockholm Healthcare database.)
Submitted by: Tom Kurt, MD, MPH, FAACT on behalf of the Geriatric Section