Increased use of selective serotonin reuptake inhibitors in patients admitted with gastrointestinal haemorrhage: a multicentre retrospective analysis.
BACKGROUND
Selective serotonin reuptake inhibitors (SSRIs) can adversely affect platelet function and impair haemostasis. Various bleeding complications have been reported in persons taking SSRIs including an increased risk of gastrointestinal haemorrhage (GIH).


OBJECTIVE
To evaluate SSRI use in patients hospitalized with GIH compared with controls.


METHODS
A retrospective, multicentre case-control study determined use of SSRIs, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, clopidogrel, coumadin and enoxaparin in patients admitted with GIH and age- and sex-matched controls. Exclusion criteria included liver disease, portal hypertension or bleeding diathesis.


RESULTS
A total of 579 cases were matched with 1000 controls. SSRI use was 19.2% in cases and 13.6% in controls [OR (95% CI) = 1.5 (1.2-2.0); P = 0.003]. NSAIDs were used by 7.3% of cases and 3.8% of controls [OR = 2.0 (1.3-3.1); P = 0.003]. SSRI use was more strongly associated with lower [1.8 (1.2-2.8)] rather than upper [1.3 (0.83-1.9)] GIH. Significant interactions existed for SSRI use with NSAIDs and aspirin.


CONCLUSIONS
Patients admitted with GIH gastrointestinal bleeding were more likely to be taking SSRIs than controls. This association exists for lower as well as upper GIH. Physicians should be aware of this risk particularly in patients already using medications that increase GIH risk.
Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
S
S
Wessinger
M
M
Kaplan
L
L
Choi
M
M
Williams
C
C
Lau
L
L
Sharp
M D
MD
Crowell
A
A
Keshavarzian
M P
MP
Jones
D001741:Black or African American; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology; D016022:Case-Control Studies; D000077144:Clopidogrel; D004347:Drug Interactions; D017984:Enoxaparin / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D014859:Warfarin / Q000009:adverse effects; D044465:White People
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D001241:Aspirin; D000077144:Clopidogrel; D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors; D013988:Ticlopidine; D014859:Warfarin