Risk of Bleeding in Patients on Full-Dose Enoxaparin With Venous Thromboembolism and Selective Serotonin Reuptake Inhibitors.
BACKGROUND
Selective serotonin reuptake inhibitors (SSRIs) are very commonly prescribed agents that are also potent antiplatelet agents.


OBJECTIVE
This study was designed compare the rate of major bleeding events between patients who were treated with low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) on SSRIs and those not on chronic SSRI therapy.


METHODS
This was a retrospective cohort study of 575 patients with a primary or secondary diagnosis of an acute VTE initiated on full-dose enoxaparin with or without an SSRI between October 1, 2009, and October 1, 2014, in a 443-bed, single tertiary care referral county teaching hospital.


RESULTS
No significant difference was found in the incidence of major bleeding in the SSRI versus non-SSRI group (19.6% vs 17.0%, P = 0.548). Ad hoc analysis demonstrated an elevated risk of major bleeding in patients on escitalopram compared with those on any of the other SSRIs (46.2% vs 15.2%, P = 0.018). Multivariate analysis demonstrated that escitalopram use-OR (95% CI) = 18.85 (1.84-193.6)-was associated with increased major bleeding, and acid suppressive therapy-0.24 (0.07-0.90); P = 0.014-was associated with decreased major bleeding in patients reporting alcohol use.


CONCLUSIONS
No difference was found in the incidence of major bleeding in patients on LMWH and SSRIs versus those on LMWH but not on SSRIs. However, ad hoc findings showed a significantly higher rate of major bleeding events in patients who received escitalopram and alcohol among patients on full-dose enoxaparin for VTE. These findings merit further exploration.
1 Texas A&M University Health Science Center, College Station, TX, USA.|2 Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Nephy G
NG
Samuel
2 Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Charles F
CF
Seifert
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000188:drug therapy*
D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D017367:Selective Serotonin Reuptake Inhibitors
alcohol; bleeding; enoxaparin; escitalopram; gastrointestinal; low-molecular-weight heparin; selective serotonin reuptake inhibitors; venous thromboembolism