title: Selective serotonin re-uptake inhibiting antidepressants and the risk of overanticoagulation during acenocoumarol maintenance treatment.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of co-medication with selective serotonin re-uptake inhibitors (SSRIs) on overanticoagulation during acenocoumarol maintenance treatment.
  
  
  METHODS
  All subjects from The Rotterdam Study who received acenocoumarol maintenance treatment between April 1 1991 and September 9 2009 were followed for the event of an international normalized ratio (INR) ≥6, until death, end of treatment or end of the study period. With the Andersen-Gill extension of the Cox proportional hazards model, risks for repeated events of overanticoagulation in relation to concomitant SSRI use were calculated.
  
  
  RESULTS
  The risk for overanticoagulation during acenocoumarol maintenance treatment was increased in combination with fluvoxamine (HR 2.63, 95% CI 1.49, 4.66) and venlafaxine (HR 2.19, 95% CI 1.21, 3.99). There was no increase in risk for the other SSRIs, but numbers of exposed cases were low for all SSRIs except paroxetine.
  
  
  CONCLUSIONS
  Fluvoxamine and venlafaxine were associated with a more than double risk of INR values ≥6 in acenocoumarol treated subjects.
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands. m.teichert@erasmusmc.nl
authors.forename: Martina
authors.initials: M
authors.lastname: Teichert
authors.forename: Loes E
authors.initials: LE
authors.lastname: Visser
authors.forename: Andrė G
authors.initials: AG
authors.lastname: Uitterlinden
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Buhre
authors.forename: Sabine
authors.initials: S
authors.lastname: Straus
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
authors.forename: Bruno H
authors.initials: BH
authors.lastname: Stricker
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects; D015331:Cohort Studies; D003511:Cyclohexanols / Q000494:pharmacology; D004347:Drug Interactions; D016666:Fluvoxamine / Q000494:pharmacology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012701:Serotonin / Q000494:pharmacology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D000069470:Venlafaxine Hydrochloride
chemical_list: D000074:Acenocoumarol; D000925:Anticoagulants; D000928:Antidepressive Agents; D003511:Cyclohexanols; D016666:Fluvoxamine; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride