A UK nested case-control study suggested that concomitant use of selective serotonin reuptake inhibitors (SSRIs) and oral anticoagulants (OACs) was associated with bleeding risk and should be closely monitored, particularly within the initial months of treatment. Between January 1998, and March 2021, 42 190 atrial fibrillation (AF) patients with major bleeding (mean age, 74.2 years; 59.8% men) were matched to 1 156 641 controls (mean age, 74.2 years; 59.8% men). Concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding compared with OACs alone (incidence rate ratios [IRR], 1.33). The risk peaked during the initial months of treatment (first 30 days of use: IRR, 1.74) and persisted for up to 6 months. The risk did not vary with age, sex, history of bleeding, chronic kidney disease, and potency of SSRIs. An association was present both with concomitant use of SSRIs and direct OACs compared with direct OAC use alone (IRR, 1.25) and concomitant use of SSRIs and vitamin K antagonists (VKAs) compared with VKA use alone (IRR, 1.36). The findings are in line with previous observational studies as well as the summary of product characteristics for different OACs, which describes SSRIs as interacting drugs as they have been shown to increase the risk of bleeding. However, the increased risk of major bleeding does not suggest withholding treatment with either SSRIs or OACs, with measures being taken to mitigate this risk. Studies suggest that OACs have lower potential for pharmacokinetic interactions with SSRIs than VKAs, and guidelines also recommend them over VKAs for the management of nonvalvular AF. Source: https://jamanetwork.com/
