Psychotropic Drugs and Outcome in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism

Pablo Javier Marchena; Inna Tzoran; Benjamin Brenner; Mar Martín; Radovan Malý; Alessandra Bura-Riviere; Reina Valle; Luis Hernández-Blasco; Juan Bosco López-Sáez; Manuel Monreal; RIETE Investigators

doi:10.1055/s-0040-1708482

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2020; 120(04): 620-626
DOI: 10.1055/s-0040-1708482

Coagulation and Fibrinolysis

Georg Thieme Verlag KG Stuttgart · New York

Psychotropic Drugs and Outcome in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism

Pablo Javier Marchena^*

¹Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain

,

Inna Tzoran^*

²Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

,

Benjamin Brenner

²Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

,

Mar Martín

³Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain

,

Radovan Malý

⁴Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Czech Republic

,

Alessandra Bura-Riviere

⁵Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France

,

Reina Valle

⁶Department of Internal Medicine, Hospital Sierrallana, Santander, Spain

,

Luis Hernández-Blasco

⁷Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain

,

Juan Bosco López-Sáez

⁸Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain

,

Manuel Monreal

⁹Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain

,

RIETE Investigators

› Institutsangaben

Abstract

Background The influence (if any) of the use of psychotropic drugs on outcome in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated.

Methods We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the risk for VTE recurrences, major bleeding, or death during the course of anticoagulant therapy, according to the use of psychotropics at baseline.

Results Among 49,007 patients with VTE enrolled from February 2009 to September 2019, total 5,230 (11%) were using psychotropics at baseline: antidepressants 3,273 (6.7%), antipsychotics 1,588 (3.2%), and anticholinesterases 369 (0.7%). During the course of anticoagulation, 1,259 patients developed VTE recurrences, 1,231 bled, and 3,988 died (fatal pulmonary embolism 269 and fatal bleeding 187). On multivariable analysis, patients using psychotropics at baseline had a similar risk for VTE recurrences (adjusted hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.58–1.12), a nonsignificantly higher risk for major bleeding (adjusted HR: 1.15; 95% CI: 0.97–1.35), and a higher risk for intracranial bleeding (adjusted HR: 1.83; 95% CI: 1.32–2.53) or death (adjusted HR: 1.44; 95% CI: 1.32–1.57) compared with those not using psychotropics. When separately analyzed, the highest risk for intracranial bleeding was found in patients using antidepressants (adjusted HR: 1.60; 95% CI: 1.08–2.37) or antipsychotics (adjusted HR: 2.02; 95% CI: 1.17–3.49) but not in those on anticholinesterases (adjusted HR: 1.69; 95% CI: 0.62–4.60).

Conclusion During the course anticoagulation for VTE, patients using psychotropics at baseline were at increased risk for intracranial bleeding.

Keywords

psychotropics - anticoagulant therapy - venous thromboembolism

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Referenzen

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