title: Selective serotonin reuptake inhibitors: measurement of effect on platelet function.
abstract: Selective serotonin reuptake inhibitors (SSRIs) reduce platelet serotonin and are associated with increased gastrointestinal bleeding, an effect that is enhanced when taken with NSAIDs or aspirin. The best method to evaluate hemorrhagic events in patients taking SSRIs has not been determined. Platelet aggregation, which is not widely available, shows SSRI inhibition of platelet function; we tested whether a platelet function analyzer could detect SSRI inhibition of platelet function. Two groups of outpatients with mood disorders were recruited; each patient was taking a stable dose of either an SSRI or bupropion for at least 6 weeks. They were tested using the platelet function analyzer-100 (PFA-100; Dade International Inc, Miami, Fla) concomitantly with platelet aggregation. Fifty-eight patients were analyzed. We detected significant differences between the groups using aggregation methods with arachidonic acid (aggregation, P = 0.00001; release, P = 0.009) and collagen (aggregation, P = 0.016; release, P = 0.006). The PFA-100 did not detect differences between the groups or results outside the reference range. The PFA-100 does not detect the inhibitory effects of SSRIs on platelet function, but it can be used to direct evaluation of bleeding in a patient taking an SSRI. Abnormal PFA-100 results suggest additional evaluation for von Willebrand disease, other platelet inhibitory medications, or underlying intrinsic platelet dysfunction.
authors.affiliation: National Institutes of Health, Warren Grant Magnuson Clinical Center, Department of Laboratory Medicine, Bethesda, MD 20892, USA. mccloskd@mail.nih.gov
authors.forename: Donna Jo
authors.initials: DJ
authors.lastname: McCloskey
authors.forename: Teodor T
authors.initials: TT
authors.lastname: Postolache
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Vittone
authors.forename: Khanh L
authors.initials: KL
authors.lastname: Nghiem
authors.forename: Jude L
authors.initials: JL
authors.lastname: Monsale
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wesley
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Rick
mesh_terms: D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology; D016642:Bupropion / Q000494:pharmacology*; D003094:Collagen / Q000494:pharmacology; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D013917:Thrombin / Q000494:pharmacology
chemical_list: D016642:Bupropion; D003094:Collagen; D004837:Epinephrine; D017367:Selective Serotonin Reuptake Inhibitors; D013917:Thrombin