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

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. Characteristics of studies included in review.

References	Name of study or source of participants	Location	Study design	Year of baseline survey	Baseline age range (years)	% male	Follow up (years)	Exposure	Outcomes reported	Type of risk estimate	No. of VTE events	Total participants	Covariates adjusted for	Study quality
Enga et al. [11]	Tromso	Norway	Prospective cohort	1994–1995	25–96	NR	12.4	Depression	VTE	HR	440	25 964	Age, sex, BMI, oestrogens, lifestyle and co-morbidities	8
Lee et al. [13]	LHID 2000	Taiwan	Retrospective cohort	2000	48.0a	38.4	11.0	Depression	VTE, DVT, and PE	HR	314	105 822	Age, sex, comorbidities of atrial fibrillation, hypertension, diabetes, CVA, heart failure, cancer	8
Wu et al. [14]	LHID 2005	Taiwan	Nested case-control	2001	63.3c	47.7	8.0	Antidepressant use	VTE	OR	1,880	13 102	Disease risk score based on comorbid medical and psychiatric illnesses (controls were matched on age and sex)	8
Parkin et al. [15]	Million Women Study	UK	Prospective cohort	1996–2001	59.9^a	0.0	7.3	Depression and antidepressant use	VTE	HR	3,922	734 092	Age, BMI, smoking, alcohol consumption, frequency of strenuous physical activity, hormone therapy, diabetes mellitus, high blood pressure, and socioeconomic status, and stratified by recruitment region	8
Parkin et al. [16]	GP database	New Zealand	Case-control	1990–1998	15–59	NR	12.2–13.5	Antidepressant use	PE	OR	13^b	263^b	Weight, combined oral contraceptive use and hormone replacement (controls matched on sex and year of birth)	6
Jick and Li [17]	UK GPRD	UK	Nested case-control	1990–2005	≤ 70	34.8	NR	Antidepressant use	VTE	OR	782	3867	Smoking, BMI (controls matched on age, sex, practice attended by case patient, index data, and duration of previous computerized record)	6
Ray et al. [18]	Administrative database	Canada	Retrospective cohort	1994–2000	≥ 65	75.0	0.9	Antidepressant use	VTE and DVT	HR	999	75 649	Age, sex, currently residing within a long-term facility, recent prior hospitalization, concurrent diagnosis of cancer, and concurrent prescription of ASA, warfarin, estrogen or lithium	7
Lacut et al. [19]	University Hospital	France	Case-control	2000–2004	68.0^a	43.3	NR	Antidepressant use	VTE	OR	677	1354	BMI, factor V Leiden, and prothrombin G20210A gene variation (controls were matched on age and gender)	6

ASA: acetylsalicylic acid; BMI: body mass index; CVA: cerebral vascular accident; DVT: deep vein thrombosis; GP: general practitioner; HR: hazard ratio; LHID: Longitudinal Health Insurance Database; NR: not reported; OR: odds ratio; PE: pulmonary embolism; UK GPRD: United Kingdom General Practice Research Database; VTE: venous thromboembolism.

^aAverage age.

^bThese numbers are based on subjects without major risk factors for VTE.

^cMean age of VTE cases.

Figure 2. Associations of depression and antidepressant use with risk of venous thromboembolism. CI: confidence interval (bars); RR: relative risk; VTE: venous thromboembolism.

Figure 3. Associations of antidepressant groups with risk of venous thromboembolism. CI: confidence interval (bars); RR: relative risk; SSRI: selective serotonin reuptake inhibitors; TCA: tricyclic antidepressant; VTE: venous thromboembolism.

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