In at least 1 study, SSRIs were found to increase the risk of exceptionally high INR values, perhaps reflecting inhibition of the cytochrome P450–mediated metabolism of warfarin. Dr Berkowitz is an employee of Bayer U.S. LLC. This model generated an estimated probability and corresponding Event rates (events per 100 patient‐years) were generated for all end points. The rate of major/NMCR bleeding was 18.57 events per 100 patient‐years versus 16.84 events per 100 patient‐years for matched comparators, with an adjusted hazard ratio (aHR) of 1.16 (95% CI, 0.95–1.43). My GP has said that all anti-depressants cause internal bleeding when taken with Clopidogrel. Serotonin promotes platelet aggregation and therefore blood clotting. Major bleeding was defined as clinically overt bleeding associated with any of the following: fatal outcome, involvement of a critical anatomic site (intracranial, spinal, ocular, pericardial, articular, retroperitoneal, or intramuscular with compartment syndrome), fall in hemoglobin concentration ≥2 g/dL, transfusion of ≥2 units of whole blood or packed red blood cells, or permanent disability. Dr Singer was supported, in part, by the Eliot B. and Edith C. Shoolman Fund of Massachusetts General Hospital (Boston, MA).Dr Hankey has served on a speaker's bureau for Bayer HealthCare Pharmaceuticals. By continuing to browse this site you are agreeing to our use of cookies.Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MADuke Clinical Research Institute, Duke University School of Medicine, Durham, NCMedical School, The University of Western Australia, Crawley, AustraliaUniversity of Cincinnati College of Medicine, Cincinnati, OHDepartment of Cardiovascular Medicine, Hospital of the University of Münster, GermanyDepartment of Psychiatry, Massachusetts General Hospital, Boston, MAUniversity of Edinburgh and Royal Infirmary of Edinburgh, United KingdomDepartment of Medicine, Stanford University, Stanford, CADuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDivision of General Internal Medicine, Massachusetts General Hospital, Boston, MAThere is concern that selective serotonin reuptake inhibitors (We found no significant increase in bleeding risk when Patients with atrial fibrillation may also have anxiety and/or depression.As a result, patients may be prescribed selective serotonin reuptake inhibitors (SSRIs) as well as anticoagulants.Given the platelet inhibitory effects of SSRIs, there is concern that the addition of SSRIs to anticoagulants may substantially raise the risk of bleeding.We assessed whether SSRIs increased the risk of bleeding in the ROCKET AF randomized trial of rivaroxaban versus warfarin in patients with atrial fibrillation.We found no strong evidence that SSRIs raised the risk of major plus nonmajor clinically relevant bleeding events when combined with anticoagulants overall, nor with either rivaroxaban or warfarin, individually.There was a suggestion that SSRIs added to warfarin might increase the risk of major bleeds, but this finding was not statistically significant.There are patients with atrial fibrillation taking anticoagulants to prevent stroke, for whom SSRIs are indicated.While physicians should be vigilant regarding bleeding risk, our results provide reassurance that SSRIs can be safely added to anticoagulants in patients with atrial fibrillation.Treatment with oral anticoagulants, including warfarin and non–vitamin K antagonist oral anticoagulants, significantly decreases the risk of ischemic stroke in patients with atrial fibrillation (AF), but also increases the risk of bleeding.The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure. SNRIs included desvenlafaxine, duloxetine, or venlafaxine.Patients must have been taking the SSRI medication for a minimum of 14 consecutive days to be considered in the medication group. Continuous variables were compared with Wilcoxon rank‐sum tests, and categorical variables were compared with Pearson chi‐square tests.Patients taking SSRIs were matched 1:1 to those not taking SSRIs using a propensity score. A 2008 case-control study showed that the risk of a GI bleed was attenuated if acid-suppressive therapy (e.g. In New York State and the founder of the Q+A website PharmacistAnswers.com reduced rate of stroke/non‐CNS among! & Development showed that the addition of SSRIs to oral anticoagulants does not substantially increase the risk bleeding... Months ago notably, any medication that decrease stomach acid HealthCare Pharmaceuticals, Boehringer Ingelheim Daiichi‐Sankyo! 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