Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study

Abajo, Francisco J. de; Rodrı́guez, Luis A. Garcı́a; Montero, Dolores

doi:10.1136/bmj.319.7217.1106

Cited by 394 publications

(329 citation statements)

References 18 publications

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“…The first group comprised SSRIs, including citalopram, fluoxetine, sertraline, paroxetine, clomipramine, and fluvoxamine. In the studies of de Abajo et al, 2,4 clomipramine was included in the SSRI group because of a rather selective effect on serotonin transport mechanisms. We followed the same strategy to enhance comparability with these previous studies.…”

Section: Exposure Definitionmentioning

confidence: 99%

“…However, treatment with SSRIs has been associated with bleeding complications, 1 and it was recently shown that treatment with SSRIs increases the risk of upper gastrointestinal bleeding. 2,3 It is thus a major concern whether SSRIs also increase the risk of hemorrhagic stroke. A recent case-control study found no association between the use of SSRIs and the risk of intracranial hemorrhage (intracerebral, subarachnoidal, subdural, and unspecified intracranial hemorrhages).…”

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confidence: 99%

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Selective Serotonin Reuptake Inhibitors and the Risk of Stroke

Tsiropoulos

Kjærsgaard

et al. 2002

Stroke

125

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Background and Purpose-Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs. Methods-We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. Results-Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates. Conclusions-Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.

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Section: Exposure Definitionmentioning

confidence: 99%

mentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and the Risk of Stroke

Tsiropoulos

Kjærsgaard

et al. 2002

Stroke

125

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“…As a result, SSRIs may be prescribed along with oral anticoagulants in patients with AF, a condition particularly common in older individuals 6. A concern is that SSRIs have been linked to increased risk of bleeding 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Indeed, the product information for SSRIs includes a warning about possible increased bleeding risk 17.…”

Section: Introductionmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation: An Analysis From the ROCKET AF Trial

Quinn

Hellkamp

Hankey

et al. 2018

JAHA

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BackgroundThere is concern that selective serotonin reuptake inhibitors (SSRIs) substantially increase bleeding risk in patients taking anticoagulants.Methods and ResultsWe studied 737 patients taking SSRIs in the ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Embolism and Stroke Trial in Atrial Fibrillation) trial of rivaroxaban compared with warfarin for the prevention of stroke/systemic embolism in patients with atrial fibrillation. These patients were propensity score matched 1:1 to 737 patients not taking SSRIs. The primary outcome measure was major and nonmajor clinically relevant bleeding events, the principal safety outcome in ROCKET AF. Over a mean 1.6 years of follow‐up, the rate of major/nonmajor clinically relevant bleeding was 18.57 events/100 patient‐years for SSRI users versus 16.84 events/100 patient‐years for matched comparators, adjusted hazard ratio (aHR) of 1.16 (95% confidence interval [CI], 0.95–1.43). The aHRs were similar in patients taking rivaroxaban (aHR 1.11 [95% CI, 0.82–1.51]) and those taking warfarin (aHR 1.21 [95% CI, 0.91–1.60]). For the rarer outcome of major bleeding, the aHR for SSRI users versus those not taking SSRIs was 1.13 (95% CI, 0.62–2.06) for rivaroxaban; for warfarin, the aHR was higher, at 1.58 (95% CI, 0.96–2.60) but not statistically significantly elevated.ConclusionsWe found no significant increase in bleeding risk when SSRIs were combined with anticoagulant therapy, although there was a suggestion of increased bleeding risk with SSRIs added to warfarin. While physicians should be vigilant regarding bleeding risk, our results provide reassurance that SSRIs can be safely added to anticoagulants in patients with atrial fibrillation.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00403767.

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“…Several observational studies also indicated increased risk for upper gastrointestinal hemorrhage in patients on SSRI therapy. One of the first observational studies was a nested case-control study in 1999 by de Abajo, Rodriguez, & Montero [7] , which noted a three times increased risk for upper gastrointestinal bleeding. Since then, several other studies have reported an association between SSRI use and spontaneous upper gastrointestinal hemorrhage [8] .…”

Section: Introductionmentioning

confidence: 99%

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Pandey¹,

Pawar²,

Verma³

2015

Int. J. Orthop. Sci.

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Background: Serotonergic antidepressants inhibit platelet aggregation, and use of these drugs has been associated with adverse bleeding events. The objective of this study was to determine the association of preoperative use of serotonergic antidepressants and perioperative bleeding in patients undergoing total knee arthroplasty. Methods: A retrospective analysis was conducted of 80 patients who underwent elective primary total knee arthroplasty in a large hospital. The index group included 40 patients who used serotonergic antidepressants in the preceding 4 weeks prior to surgery, and the reference group included 40 patients who were nonusers. The primary outcome was the change in hematocrit; and the secondary outcomes were the amount of estimated blood loss and the requirement for blood transfusion. Results: Comparing the patients who were using SSRIs and those who were not, no statistically significant difference was observed in the level of the three dependent variables of Hct change, estimated blood loss and transfusion units (p > .05). The effect of the use of SSRI on preoperative hemoglobin and hematocrit levels, however, was significant (p = .027; p = .023, respectively), as patients who used SSRI had significantly lower levels of preoperative hemoglobin and preoperative hematocrit. Conclusions: This study concluded that patients undergoing total knee arthroplasty who continued to use serotonergic antidepressants did not show a statistically significant perioperative blood loss based on the three outcome measures of change in hematocrit, blood transfusion needs, and estimated blood loss.

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Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study

Abstract: Objective To examine the association between selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding.

Cited by 394 publications

References 18 publications

Selective Serotonin Reuptake Inhibitors and the Risk of Stroke

Selective Serotonin Reuptake Inhibitors and the Risk of Stroke

Selective Serotonin Reuptake Inhibitors and Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation: An Analysis From the ROCKET AF Trial

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

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