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Association Between Antidepressants and Venous Thromboembolism in Taiwan

Wu, Chi-Shin MD, MS*; Chang, Chia-Ming MD, PhD; Chen, Chuan-Yu PhD‡§; Wu, Erin Chia-Hsuan MD; Wu, Kuan-Yi MD; Liang, Hsin-Yi MD; Chao, Yu-Lin MD; Chung, Wen-Shen Isabella MS*; Tsai, Hui-Ju MPH, PhD#**

Journal of Clinical Psychopharmacology: February 2013 - Volume 33 - Issue 1 - p 31–37
doi: 10.1097/JCP.0b013e3182777425
Original Contributions

Objective: To investigate the association between venous thromboembolism (VTE) and antidepressant use in an Asian population.

Methods: The authors conducted a nested case-control study of 1888 patients with VTE and 11,222 matched controls enrolled in the National Health Insurance Research Database in Taiwan from 2001 to 2009. The antidepressant exposure status and potential confounding factors were measured and included in the analyses. Conditional logistic regressions were applied to determine the effect of antidepressant use on VTE.

Results: We found a significant association of current antidepressant use with VTE in the total study sample (adjusted odds ratio [aOR], 1.59; 95% confidence interval (CI), 1.27–2.00). With regard to antidepressant classes and potency, we found that tricyclic antidepressants (aOR, 1.56; 95% CI, 1.11–2.18), serotonin 5-HT2A receptor blockers (aOR, 2.03; 95% CI, 1.27–3.24), and antidepressants with a low potency of serotonin reuptake inhibition (aOR, 1.57; 95% CI, 1.18–2.08) were associated with a significantly increased risk of VTE. When further stratifying by age, sex, and comorbid conditions, the VTE risk with antidepressant use was elevated among young and middle-aged adults, but not among the elderly. In addition, an elevated risk of VTE was observed in women and subjects without severe comorbid conditions, but not in men and subjects with severe comorbid conditions.

Conclusions: There was a small increase in VTE risk with antidepressant use. The prescription of antidepressant drugs should be cautious, and especially, should be based on clinical evaluations of benefits and risks. The underlying mechanisms of the interaction between antidepressants and VTE warrant further investigation.

From the *Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City; †Department of Psychiatry, Chang Gung Memorial Hospital, Lin-Kou & Chang Gung University, Lin-Kou; ‡Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei; §Division of Mental Health and Addiction Medicine, Institute of Population Health Sciences, National Health Research Institutes, Zhunan; ∥Graduate Institute of Humanity in Medicine, Taipei Medical University, Taipei; ¶Institute of Medical Science, Tzu Chi University, Hualien, Taiwan; #Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; and **Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.

Received September 6, 2011; accepted after revision April 27, 2012.

Reprints: Hui-Ju Tsai, MPH, PhD, Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (e-mail: tsaihj@nhri.org.tw; h-tsai@northwestern.edu).

Dr. Wu is supported in part by the Far Eastern Memorial Hospital (PI: Wu, FEMH 99-2314-B-418-008). Dr. Tsai is supported in part by a grant from the National Health Research Institutes (PI: Tsai, PH-099-PP-56, PH-100-PP-14, PH-101-PP-14, PH-101-SP-14).

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes (Registered numbers: 99081, 99136, 99287, and 100007). The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health or National Health Research Institutes.

© 2013 Lippincott Williams & Wilkins, Inc.