ArticlePloS one2011
Antidepressant-warfarin interaction and associated gastrointestinal bleeding risk in a case-control study.
Article in PloS one, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 38 papers, 9 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 9 syntheses or guidelines pooled it, 80 citations in OpenAlex.
- Risk of gastrointestinal bleeding by specific SSRIs and SNRIs: A systematic review and meta-analysis.British journal of clinical pharmacology · 2026Pooled it
- Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis.Annals of medicine · 2022Pooled it
- Meta-analysis of coagulation parameters associated with disease severity and poor prognosis of COVID-19.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2020Pooled it
- Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.Chinese journal of integrative medicine · 2020Pooled it
- Risk of Bleeding with Exposure to Warfarin and Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review and Meta-Analysis.Thrombosis and haemostasis · 2020Pooled it
- Bleeding events attributable to concurrent use of warfarin and other medications in high-risk elderly: meta-analysis and Italian population-based investigation.European journal of clinical pharmacology · 2018Pooled it
- Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis.BMJ open · 2018Pooled it
- Pooled it
- Pooled it
- Trial
- Absence of pharmacovigilance signals for bleeding events associated with warfarin-SSRI drug interactions: a comparative analysis of FAERS and CVARD databases.Therapeutic advances in drug safety · 2026Article
- Apathy and cognitive decline as the first presentation of SLE-associated vascular dementia: a case report.Neuropsychiatrie : Klinik, Diagnostik, Therapie und Rehabilitation : Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater · 2025Article
- All-Cause Mortality and Bleeding Risks Associated With Serotonin Reuptake Inhibitors in Patients With End-Stage Kidney Disease and Depression: A Nationwide Cohort Study.Psychiatry investigation · 2025Article
- Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding.JAMA network open · 2024Article
- Selective Serotonin Reuptake Inhibitor (SSRI) Bleeding Risk: Considerations for the Consult-Liaison Psychiatrist.Current psychiatry reports · 2023Review
- Does coprescribing nonsteroidal anti-inflammatory drugs and oral anticoagulants increase the risk of major bleeding, stroke and systemic embolism?British journal of clinical pharmacology · 2022Article
- Drug Interactions Affecting Oral Anticoagulant Use.Circulation. Arrhythmia and electrophysiology · 2022Review
- Management of Systemic Medical Emergencies Associated with Psychotropic Medications.Indian journal of psychiatry · 2022Article
- Risk of Bleeding Associated with Antidepressant Drugs: The Competitive Impact of Antithrombotics in Quantitative Signal Detection.Drugs - real world outcomes · 2021Article
- Association of Type of Antidepressant Initiation with Bleeding Risk in Atrial Fibrillation Patients Taking Oral Anticoagulants.Drugs - real world outcomes · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundBleeding is the most common and worrisome adverse effect of warfarin therapy. One of the factors that might increase bleeding risk is initiation of interacting drugs that potentiate warfarin. We sought to evaluate whether initiation of an antidepressant increases the risk of hospitalization for gastrointestinal bleeding in warfarin users. METHODOLOGY/PRINCIPAL
findingsMedicaid claims data (1999-2005) were used to perform an observational case-control study nested within person-time exposed to warfarin in those ≥18 years. In total, 430,455 warfarin users contributed 407,370 person-years of warfarin use. The incidence rate of hospitalization for GI bleeding among warfarin users was 4.48 per 100 person-years (95% CI, 4.42-4.55). Each gastrointestinal bleeding cases was matched to 50 controls based on index date and state. Warfarin users had an increased odds ratio of gastrointestinal bleeding upon initiation of citalopram (OR = 1.73 [95% CI, 1.25-2.38]), fluoxetine (OR = 1.63 [95% CI, 1.11-2.38]), paroxetine (OR = 1.64 [95% CI, 1.27-2.12]), amitriptyline (OR = 1.47 [95% CI, 1.02-2.11]). Also mirtazapine, which is not believed to interact with warfarin, increased the risk of GI bleeding (OR = 1.75 [95% CI, 1.30-2.35]). CONCLUSIONS/SIGNIFICANCE: Warfarin users who initiated citalopram, fluoxetine, paroxetine, amitriptyline, or mirtazapine had an increased risk of hospitalization for gastrointestinal bleeding. However, the elevated risk with mirtazapine suggests that a drug-drug interaction may not have been responsible for all of the observed increased risk.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.