The relevance of depressive symptoms for the outcome of patients receiving vitamin K antagonists: results from the thrombEVAL cohort study.
Published on Jul 23, 2021in European Heart Journal - Cardiovascular Pharmacotherapy6.617
· DOI :10.1093/EHJCVP/PVZ085
AIMS: Although depressive symptoms are highly prevalent in patients receiving oral anticoagulation (OAC), the relevance of depression for the outcome of anticoagulated individuals is unknown. METHODS AND RESULTS: We analyzed data from the multi-center cohort study thrombEVAL (NCT01809015), investigating the efficacy of OAC with vitamin K-antagonists. There was an independent study monitoring, and an independent review panel assessed the endpoints. Out of n = 1,558 participants, information about depressive symptoms, as measured by the two-item screener PHQ-2, was available in n = 1,405 individuals. The mean follow-up period was 28.04 months, with a standard deviation of 11.52 months. In multivariable Cox regression analysis, baseline PHQ-2 sum score was a strong and robust predictor of clinically-relevant bleeding (hazard ratio (HR) 1.13, 95% confidence interval 1.03-1.24; p = 0.011) and all-cause mortality (HR 1.18, 1.08-1.28; p = 0.001) independent of age, sex, high school graduation, partnership, clinical profile, intake of SSRI, and quality of OAC therapy. Individuals with clinically significant depressive symptoms (PHQ-2 >/=3) had a 57% increased risk for clinically relevant bleeding (fully adjusted HR 1.57, 1.08-2.28) and 54% greater risk for death (fully adjusted HR 1.54, 1.09-2.17). There was no association of depressive symptoms with thromboembolic events. For hospitalization, individuals with depressive symptoms (PHQ-2 >/=3) did not experience an elevated risk in the fully adjusted model (HR 1.08, 0.86, 1.35; p = 0.52). CONCLUSIONS: Assessment of depression by the PHQ-2 provided independent long-term prognostic information beyond common biomedical risk factors. These findings highlight the need for targeting depressive symptoms in the management of patients receiving OAC therapy.