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Depression, antidepressant use, and risk of venous thromboembolism: systematic review and meta-analysis of published observational evidence.

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Depression, antidepressant use, and risk of venous thromboembolism: systematic review and meta-analysis of published observational evidence.

Ann Med. 2018 Jul 12;:1-17

Authors: Kunutsor SK, Seidu S, Khunti K

Abstract
PURPOSE: Evidence on the association between depression, antidepressant use and venous thromboembolism (VTE) risk is conflicting. We conducted a systematic review and meta-analysis of published observational studies evaluating the associations of depression and antidepressant use with VTE risk.
DESIGN: Eligible studies were identified in a literature search of MEDLINE, Embase, Web of Science and reference list of relevant studies up to April 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated aggregated using random effects models.
RESULTS: Eight observational studies with data on 960 113 non-overlapping participants and 9027 VTE cases were included. The pooled RR (95% CI) for VTE comparing antidepressant use with no antidepressant use was 1.27 (1.06-1.51). Tricyclic antidepressants, selective serotonin reuptake inhibitors and other antidepressants were each associated with an increased VTE risk; 1.16 (1.06-1.27), 1.12 (1.02-1.23), and 1.59 (1.21-2.09) respectively. In pooled analysis of three studies that compared patients with depression versus individuals without depression, the RR for VTE was 1.31 (1.13-1.53).
CONCLUSION: Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased VTE risk. The effect of antidepressant drugs on VTE may be a class effect. The mechanistic pathways underlying these associations deserve further evaluation. Systematic review registration: PROSPERO 2018: CRD42018095595.

PMID: 30001640 [PubMed – as supplied by publisher]

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