Das Blutungsrisiko unter Antidepressiva verstehen und einschätzen

Zusammenfassung

Antidepressiva, insbesondere die selektiven Serotoninwiederaufnahmehemmer (SSRI), sind die meistverordnete psychopharmakologische Arzneistoffgruppe, weshalb eine genaue Kenntnis der zu erwartenden unerwünschten Arzneimittelwirkungen unabdingbar ist. Das erhöhte Risiko für Blutungsereignisse ist vor allem bei Patienten, die mit SSRI behandelt werden, gut belegt. Mit wenigen Ausnahmen können jedoch auch die anderen antidepressiven Arzneistoffgruppen Einfluss auf die Blutgerinnung nehmen und somit das Blutungsrisiko erhöhen. In der nachfolgenden Übersichtsarbeit wird das thrombozytäre Serotoninsystem vorgestellt und die Angriffspunkte der unterschiedlichen Antidepressiva erläutert. Anschließend wird die zur Verfügung stehende Literatur zu Blutungen unter den jeweiligen Antidepressivaklassen bzw. einzelnen Substanzen vorgestellt, wobei hier nach Möglichkeit jeweils Daten aus Meta-Analysen herangezogen werden. Neben dem allgemeinen Blutungsrisiko werden zudem einzelne Blutungsentitäten betrachtet, wie gastrointestinale und Hirnblutungen. Zuletzt werden die Auswirkungen von anderen blutgerinnungsfördernden Arzneistoffen (Nichtsteroidale Antirheumatika, Thrombozytenaggregationshemmer und Antikoagulanzien) in Kombination mit Antidepressiva diskutiert. Mit dem vorgestellten Wissen soll es Behandlern in Zukunft leichter fallen Entscheidungen hinsichtlich einer geeigneten antidepressiven Pharmakotherapie anhand der patientenindividuellen Risikokonstellation zu treffen.

Abstract

Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are the most commonly prescribed psychopharmacological drug group. Thus, a precise knowledge of the expected adverse drug reactions is indispensable. The increased risk of bleeding events is well documented, especially in patients treated with SSRIs. However, many other antidepressant drug groups have also been implicated in increasing the risk of bleeding. In the following review, the thrombocytic serotonin system and the respective targets of the different antidepressants are explained. Subsequently, the available literature on bleeding under the respective antidepressant classes or individual substances is presented, using data from meta-analyses whenever possible. In addition to the risk of bleeding in general, individual bleeding entities are also considered, such as gastrointestinal and cerebral hemorrhages. Finally, the effects of other drugs that increase the risk of bleeding (i. e., nonsteroidal anti-inflammatory drugs, platelet aggregation inhibitors and anticoagulants) in combination with antidepressant drugs are discussed. The information presented here is meant to guide practitioner’s decision making regarding an appropriate antidepressant pharmacotherapy based on the patient's individual risk constellation.

Schlüsselwörter

Antidepressiva - Gerinnung - Blutung - Thrombozyten - Serotonin

Key words

antidepressant drugs - hemostasis - bleeding - thrombocyte - serotonin

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