title: An association between selective serotonin reuptake inhibitor use and serious upper gastrointestinal bleeding.
abstract: OBJECTIVE
  In vitro studies have shown that selective serotonin reuptake inhibitors (SSRIs) inhibit platelet aggregation. It is controversial whether use of SSRIs is a cause of clinically important bleeding; results from observational studies have been equivocal.
  
  
  METHODS
  A population-based case-control study was conducted in Denmark. The 3652 cases all had a first discharge diagnosis of serious upper gastrointestinal bleeding (UGB) from 1995 to 2006. Controls (n = 36,502), matched for age and sex, were selected by risk-set sampling. Data on drug exposure and medical history were retrieved from a prescription database and the county's patient register. Confounders were controlled for by conditional logistic regression and the case-crossover design.
  
  
  RESULTS
  The adjusted odds ratio (OR) of UGB among current, recent, and past users of SSRIs was 1.67 (95% confidence interval [CI], 1.46-1.92), 1.88 (95% CI, 1.42-2.5), and 1.22 (95% CI, 1.07-1.39). The adjusted OR for concurrent use of SSRI and nonsteroidal anti-inflammatory drugs (NSAIDs) was 8.0 (95% CI, 4.8-13). The adjusted OR for the concurrent use of NSAID, aspirin, and SSRI was 28 (95% CI, 7.6-103). Of the UGB cases, 377 were current users of SSRI; the adjusted OR for UGB in the case crossover analysis was 2.8 (95% CI, 2.2-3.6). The adjusted OR among users of proton pump inhibitors was 0.96 (95% CI, 0.50-1.82).
  
  
  CONCLUSIONS
  Use of SSRI was associated with UGB, consistent with its antiplatelet effects. SSRIs should be prescribed with caution for patients at high risk for UGB.
authors.affiliation: Research Unit of Clinical Pharmacology, University of Southern Denmark, Odence, Denmark. mdall@health.sdu.dk
authors.forename: Michael
authors.initials: M
authors.lastname: Dall
authors.forename: Ove B
authors.initials: OB
authors.lastname: Schaffalitzky de Muckadell
authors.forename: Annmarie Touborg
authors.initials: AT
authors.lastname: Lassen
authors.forename: Jane Møller
authors.initials: JM
authors.lastname: Hansen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003718:Denmark; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors