Setor K Kunutsor1,2, Samuel Seidu3,4, Kamlesh Khunti3,4. 1. a National Institute for Health Research Bristol Biomedical Research Centre , University Hospitals Bristol NHS Foundation Trust and University of Bristol , Bristol , UK. 2. b Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit , University of Bristol, Learning & Research Building (Level 1) , Southmead Hospital , Bristol , UK. 3. c Leicester Diabetes Centre, Leicester General Hospital , Leicester , UK. 4. d Diabetes Research Centre , University of Leicester, Leicester General Hospital , Leicester , UK.
Abstract
PURPOSE: Evidence on the association between depression, antidepressant use and venous thromboembolism (VTE) risk is conflicting. We conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk. DESIGN: Eligible studies were identified in a literature search of MEDLINE, Embase, Web of Science and reference list of relevant studies up to April 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were aggregated using random effects models. RESULTS: Eight observational studies with data on 960 113 nonoverlapping participants and 9027 VTE cases were included. The pooled RR (95% CI) for VTE comparing antidepressant use with no antidepressant use was 1.27 (1.06-1.51). Tricyclic antidepressants, selective serotonin reuptake inhibitors and other antidepressants were each associated with an increased VTE risk; 1.16 (1.06-1.27), 1.12 (1.02-1.23), and 1.59 (1.21-2.09), respectively. In pooled analysis of three studies that compared patients with depression versus individuals without depression, the RR for VTE was 1.31 (1.13-1.53). CONCLUSIONS: Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased VTE risk. The effect of antidepressant drugs on VTE may be a class effect. The mechanistic pathways underlying these associations deserve further evaluation. Systematic review registration: PROSPERO 2018: CRD42018095595 Key messages Emerging evidence suggests that depression and antidepressant use may be associated with venous thromboembolism (VTE) risk, but the evidence is conflicting. This first systematic review and meta-analysis of observational studies shows that depression and use of antidepressants are each associated with an increased risk of VTE. There may be a class effect of antidepressant drugs on VTE.
PURPOSE: Evidence on the association between depression, antidepressant use and venous thromboembolism (VTE) risk is conflicting. We conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk. DESIGN: Eligible studies were identified in a literature search of MEDLINE, Embase, Web of Science and reference list of relevant studies up to April 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were aggregated using random effects models. RESULTS: Eight observational studies with data on 960 113 nonoverlapping participants and 9027 VTE cases were included. The pooled RR (95% CI) for VTE comparing antidepressant use with no antidepressant use was 1.27 (1.06-1.51). Tricyclic antidepressants, selective serotonin reuptake inhibitors and other antidepressants were each associated with an increased VTE risk; 1.16 (1.06-1.27), 1.12 (1.02-1.23), and 1.59 (1.21-2.09), respectively. In pooled analysis of three studies that compared patients with depression versus individuals without depression, the RR for VTE was 1.31 (1.13-1.53). CONCLUSIONS: Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased VTE risk. The effect of antidepressant drugs on VTE may be a class effect. The mechanistic pathways underlying these associations deserve further evaluation. Systematic review registration: PROSPERO 2018: CRD42018095595 Key messages Emerging evidence suggests that depression and antidepressant use may be associated with venous thromboembolism (VTE) risk, but the evidence is conflicting. This first systematic review and meta-analysis of observational studies shows that depression and use of antidepressants are each associated with an increased risk of VTE. There may be a class effect of antidepressant drugs on VTE.
Authors: Giovanni Ostuzzi; Davide Papola; Chiara Gastaldon; Georgios Schoretsanitis; Federico Bertolini; Francesco Amaddeo; Alessandro Cuomo; Robin Emsley; Andrea Fagiolini; Giuseppe Imperadore; Taishiro Kishimoto; Giulia Michencigh; Michela Nosé; Marianna Purgato; Serdar Dursun; Brendon Stubbs; David Taylor; Graham Thornicroft; Philip B Ward; Christoph Hiemke; Christoph U Correll; Corrado Barbui Journal: BMC Med Date: 2020-07-15 Impact factor: 8.775
Authors: H Javelot; C Straczek; G Meyer; C Gitahy Falcao Faria; L Weiner; D Drapier; E Fakra; P Fossati; S Weibel; S Dizet; B Langrée; M Masson; R Gaillard; M Leboyer; P M Llorca; C Hingray; E Haffen; A Yrondi Journal: Encephale Date: 2021-09-02 Impact factor: 1.291