TABLE 6.
Risk of major bleeding among patients with AF taking dabigatran/apixaban with or without concurrent antidepressants.
| Concurrent medication | Person- Quarters with DOAC use | No. of Bleeding Events | Crude Major Bleeding Incidence Rate (95% CI) per 1000 Person-Years |
*Adjusted Incidence Rate (95% CI) per 1000 Person-Years |
*Adjusted Rate Ratio (95% CI) |
|||
| Major bleeding (Dabigatran) |
||||||||
| SNRI | ||||||||
| with | 2665 | 39 | 59.57 | (43.42–81.72) | 59.13 | (43.14–81.04) | 1.32 | (0.96–1.83) |
| †without | 267 899 | 2678 | 40.49 | (38.87–42.17) | 44.64 | (41.81–47.66) | 1 | |
| SSRI | ||||||||
| with | 9680 | 119 | 49.27 | (40.70–59.65) | 49.77 | (41.17–60.17) | 1.09 | (0.90–1.32) |
| †without | 260 884 | 2598 | 40.35 | (38.72–42.05) | 45.77 | (43.58–48.08) | 1 | |
| TCA | ||||||||
| with | 10242 | 116 | 45.58 | (37.80–54.96) | 45.65 | (37.87–55.03) | 1.05 | (0.86–1.27) |
| †without | 260 322 | 2601 | 40.48 | (38.84–42.18) | 43.61 | (41.64–45.68) | 1 | |
| TeCA | ||||||||
| with | 7252 | 98 | 54.2 | (43.76–67.12) | 54.62 | (44.16–67.57) | 1.19 | (0.95–1.47) |
| †without | 263 312 | 2619 | 40.3 | (38.68–41.98) | 46.09 | (43.90–48.39) | 1 | |
| Others | ||||||||
| with | 1293 | 12 | 36.75 | (20.00- 67.54) | 37.44 | (20.56- 68.19) | 0.9 | (0.49 - 1.65) |
| †without | 269 271 | 2705 | 40.69 | (39.08- 42.38) | 41.48 | (39.31- 43.78) | 1 | |
| Intracerebral hemorrhage (Dabigatran) | ||||||||
| SSRI | ||||||||
| with | 9680 | 26 | 10.78 | (7.31–15.90) | 10.9 | (7.41–16.03) | #1.55 | (1.04–2.33) |
| †without | 260 884 | 364 | 5.64 | (5.07–6.26) | 7.01 | (6.15–8.00) | 1 | |
| Major bleeding (Apixaban) | ||||||||
| SNRI | ||||||||
| with | 813 | 19 | 95.03 | (61.46–146.94) | 94.32 | (60.87–146.17) | #1.63 | (1.04–2.55) |
| †without | 89 336 | 1079 | 49.05 | (46.00–52.30) | 57.76 | (50.47–66.11) | 1 | |
| SSRI | ||||||||
| with | 3385 | 44 | 52.39 | (38.97–70.42) | 52.48 | (39.14–70.36) | 0.95 | (0.70–1.28) |
| †without | 86 764 | 1054 | 49.34 | (46.24–52.65) | 55.52 | (51.12–60.29) | 1 | |
| TCA | ||||||||
| with | 3127 | 43 | 55.22 | (40.63–75.05) | 55.57 | (41.01–75.30) | 1.1 | (0.80–1.50) |
| †without | 87 022 | 1055 | 49.25 | (46.15–52.55) | 50.74 | (47.19–54.55) | 1 | |
| TeCA | ||||||||
| with | 2477 | 39 | 63.62 | (45.97–88.03) | 63.74 | (46.04–88.23) | 1.12 | (0.80–1.57) |
| †without | 87 672 | 1059 | 49.06 | (45.98–52.33) | 56.75 | (52.43–61.43) | 1 | |
| Others | ||||||||
| with | 511 | 6 | 46.19 | (20.27–105.24) | 47.32 | (21.32–105.02) | 0.86 | (0.39–1.92) |
| †without | 89 638 | 1092 | 49.47 | (46.41–52.73) | 54.93 | (50.03–60.31) | 1 | |
*Adjusted by inverse probability of treatment weighting using the propensity score (gender, age, medical utilization, hypertension, myocardial infarction, congestive heart failure, percutaneous coronary intervention, coronary bypass surgery, peripheral vascular disease, cerebrovascular disease, ischemic stroke, transient ischemic attack, hemiplegia or paraplegia, dementia, epilepsy, diabetes mellitus, chronic kidney disease, chronic pulmonary disease, peptic ulcer disease, liver disease, malignancy, anemia, rheumatic disease, human immunodeficiency virus infection, antibiotics and antifungal drugs, antiepileptics, antihypertensives, antiplatelets, bisphosphate, cardiovascular drugs, cyclosporine, glucocorticoid, insulin, lipid lower drugs, non-steroid anti-inflammatory drugs, residence, income level, and occupation; see Tables 1, 2 and Supplementary Tables 2–4).
†“Without” indicates dabigatran or apixaban alone.
#P < 0.05, compared with dabigatran or apixaban alone.
DOAC, direct oral anticoagulant; SNRI, selective serotonin–norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitors; TCA, tricyclic antidepressant; TeCA, tetracyclic antidepressants.