Blutungsrisiko unter Antidepressiva mit Hemmung der Serotoninwiederaufnahme

Zusammenfassung

Gegenstand und Ziel: Blutungsereignisse unter Therapie mit Antidepressiva, die die Serotoninwiederaufnahme hemmen (SRI), sind in den Fokus der klinischen und wissenschaftlichen Aufmerksamkeit gerückt. In der vorliegenden Übersichtsarbeit wird ein Überblick über den Kenntnisstand zu SRI-assoziierten Blutungen, insbesondere in Hinblick auf möglichen Pathomechanismen und verschiedene Blutungslokalisationen gegeben. Material und Methoden: Es wurde eine narrative Übersichtsarbeit erstellt. Die Literaturrecherche wurde in der bibliografischen Datenbank MEDLINE durchgeführt. Ergebnisse: Zahlreiche Studien deuten darauf hin, dass SRI, insbesondere SSRI, das Risiko für obere gastrointestinale Blutungen erhöhen können; eine Komedikation mit NSAID oder Thrombozytenaggregationshemmern erhöht dieses Risiko deutlich. Die Datenlage zu anderen Blutungslokalisationen ist für sichere Bewertungen gegenwärtig unzureichend. Es gibt Hinweise auf einen positiven Zusammenhang zwischen der Affinität eines SRI zum Serotonintransporter (5-HTT) und dem assoziierten Blutungsrisiko. Schlussfolgerungen und klinische Relevanz: Ein erhöhtes Risiko für Blutungen (insbesondere obere gastrointestinale Blutungen) durch SRI sowie eine Erhöhung dieses Risikos durch NSAID und/oder Thrombozytenaggregationshemmer sollte bei der Verordnung von SRI, insbesondere von SRI mit hoher Affinität zum 5-HTT (z. B. SSRI), beachtet werden.

Summary

Objective: Hemorrhages associated with the use of antidepressants that inhibit serotonin reuptake (SRI) have become a focus of attention in clinical practice and science. This review article provides an overview of the currently available data regarding bleeding events associated with SRI with a focus on pathophysiology and different sites of bleeding. Material and methods: A narrative review article was created. Literature search was performed in the bibliographic database of MEDLINE. Results: Numerous studies have demonstrated an increased risk for upper gastrointestinal bleeding related to SRI, particularly, SSRI; comedication with NSAID or anti-platelet agents increases this risk remarkably. The currently available data does not allow reliable evaluation regarding other sites of bleeding. There is indication for an association between the affinity of an SRI to the serotonin transporter (5-HTT) and the associated risk of bleeding. Conclusion: An increased bleeding risk of bleeding (particularly upper gastrointestinal bleedings) associated with the use of SRI and an additionally increased risk under comedication with NSAID and/or antiplatelet agents should be taken into account, especially regarding SRI with high affinity to the 5-HTT (e. g., SSRI).

Schlüsselwörter

Antidepressiva - Psychopharmaka - Serotoninwiederaufnahmehemmer

Keywords

Antidepressant drugs - psychotropic drugs - serotonin reuptake inhibitor

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