fluvoxamine and Hemorrhage

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.. 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.. 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.. Fluvoxamine and venlafaxine were associated with a more than double risk of INR values ≥6 in acenocoumarol treated subjects.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Antidepressive Agents; Blood Coagulation; Cohort Studies; Cyclohexanols; Drug Interactions; Fluvoxamine; Hemorrhage; Humans; Middle Aged; Proportional Hazards Models; Risk Factors; Selective Serotonin Reuptake Inhibitors; Serotonin; Venlafaxine Hydrochloride

Patients prescribed antiplatelet treatment to prevent recurrent acute myocardial infarction are often also given a selective serotonin reuptake inhibitor (SSRI) to treat coexisting depression. Use of either treatment may increase the risk of bleeding. We assessed the risk of bleeding among patients taking both medications following acute myocardial infarction.. We conducted a retrospective cohort study using hospital discharge abstracts, physician billing information, medication reimbursement claims and demographic data from provincial health services administrative databases. We included patients 50 years of age or older who were discharged from hospital with antiplatelet therapy following acute myocardial infarction between January 1998 and March 2007. Patients were followed until admission to hospital due to a bleeding episode, admission to hospital due to recurrent acute myocardial infarction, death or the end of the study period.. The 27,058 patients in the cohort received the following medications at discharge: acetylsalicylic acid (ASA) (n = 14,426); clopidogrel (n = 2467), ASA and clopidogrel (n = 9475); ASA and an SSRI (n = 406); ASA, clopidogrel and an SSRI (n = 239); or clopidogrel and an SSRI (n = 45). Compared with ASA use alone, the combined use of an SSRI with antiplatelet therapy was associated with an increased risk of bleeding (ASA and SSRI: hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.08-1.87; ASA, clopidogrel and SSRI: HR 2.35, 95% CI 1.61-3.42). Compared with dual antiplatelet therapy alone (ASA and clopidogrel), combined use of an SSRI and dual antiplatelet therapy was associated with an increased risk of bleeding (HR 1.57, 95% CI 1.07-2.32).. Patients taking an SSRI together with ASA or dual antiplatelet therapy following acute myocardial infarction were at increased risk of bleeding.

Topics: Adrenal Cortex Hormones; Age Factors; Aged; Anemia; Angioplasty; Anticoagulants; Antihypertensive Agents; Aspirin; Canada; Citalopram; Clopidogrel; Cohort Studies; Drug Therapy, Combination; Female; Fluoxetine; Fluvoxamine; Heart Failure; Hemorrhage; Humans; Hypoglycemic Agents; Male; Middle Aged; Myocardial Infarction; Neoplasms; Paroxetine; Peptic Ulcer; Platelet Aggregation Inhibitors; Renal Insufficiency; Retrospective Studies; Risk; Risk Factors; Secondary Prevention; Selective Serotonin Reuptake Inhibitors; Sertraline; Sex Factors; Ticlopidine

Topics: Adult; Ascorbic Acid; Ecchymosis; Female; Fluvoxamine; Hemorrhage; Humans; Menorrhagia; Panic Disorder; Paroxetine

Topics: Adult; Ecchymosis; Epistaxis; Fluvoxamine; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Male; Purpura; Selective Serotonin Reuptake Inhibitors

Fluoxetine (Prozac) and fluvoxamine (Fevarin) are nontricyclic serotonin (5-hydroxytryptamine) reuptake inhibitors prescribed for the treatment of depression. Since these drugs block serotonin reuptake in platelets also, they might under certain conditions lead to clinically significant platelet dysfunction. Four patients are described who developed bleeding during treatment with either fluoxetine or fluvoxamine.

Topics: Adult; Female; Fluoxetine; Fluvoxamine; Hematoma; Hemorrhage; Humans