Moderate
Probable
Descrição
Sertraline can modestly increase warfarin anticoagulation through weak CYP2C9 inhibition combined with SSRI-mediated platelet serotonin depletion.
Mecanismo
Sertraline weakly inhibits CYP2C9, mildly increasing S-warfarin exposure; serotonin depletion in platelets reduces aggregation response, adding a pharmacodynamic component.
Significância Clínica
INR elevations are typically <20%; however, the platelet effect increases bleeding risk even within the therapeutic INR range.
Conduta
Monitor INR when starting or stopping sertraline; educate patients about signs of bleeding. Use caution with other bleeding risk factors.