Selective serotonin reuptake inhibitors and risk of hemorrhagic stroke.
OBJECTIVE
Selective serotonin reuptake inhibitors (SSRI) are widely prescribed. Several reports have observed an increased bleeding risk associated with SSRI use, which is hypothesized to be secondary to their antiplatelet effect.


METHODS
We tested the hypothesis that SSRIs increase the risk for or potentiate the risk of hemorrhagic stroke associated with antiplatelets and anticoagulants.


RESULTS
In multivariate analysis, we found no increased risk associated with SSRI use for intracerebral hemorrhage (odds ratio=1.1, 95% CI: 0.7 to 1.8; P=0.63) or subarachnoid hemorrhage (odds ratio=0.6, 95% CI: 0.4 to 1.0; P=0.054). In addition, potentiation of risk with warfarin or antiplatelets was not observed.


CONCLUSIONS
Further studies with larger populations would be needed to exclude a small increase in intracranial hemorrhage risk with SSRI use.
Kharofa
Jordan
J
Sekar
Padmini
P
Haverbusch
Mary
M
Moomaw
Charles
C
Flaherty
Matthew
M
Kissela
Brett
B
Broderick
Joseph
J
Woo
Daniel
D
D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D003866:Depressive Disorder / Q000188:drug therapy; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012307:Risk Factors; D012701:Serotonin / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects
D010975:Platelet Aggregation Inhibitors; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D014859:Warfarin