SSRI/SNRI Use is Not Associated with Increased Risk of Delayed Cerebral Ischemia After aSAH.
BACKGROUND
To determine the effect of selective serotonin reuptake inhibitor (SSRI)/selective norepinephrine reuptake inhibitor (SNRI) use on the risk of symptomatic vasospasm and delayed cerebral ischemia (DCI) in patients hospitalized with aneurysmal subarachnoid hemorrhage (aSAH).


METHODS
Retrospective review of consecutive patients with aSAH at Mayo Clinic, Rochester from January 2001 to December 2013. The variables collected and analyzed included age, sex, SSRI/SNRI use, active smoking, transfusion, modified Fisher score, WFNS grade, and outcome at discharge. Multivariate logistic regression analysis was used to evaluate factors associated with DCI, symptomatic vasospasm, and poor outcome (modified Rankin score 3-6) within 1 year.


RESULTS
579 [females 363 (62.7%)] patients with a median age of 55 (IQR 47-65) years were admitted with aSAH during the study period. WFNS at nadir was IV-V in 240 (41.5%), and modified Fisher score was 3-4 in 434 (75.0%). 81 (13.9%) patients had been prescribed an SSRI or SNRI prior to admission and all continued to receive these medications during hospitalization. Symptomatic vasospasm was present in 154 (26.4%), radiological infarction in 172 (29.5%), and DCI in 250 (42.9%) patients. SSRI/SNRI use was not associated with the occurrence of DCI (p = 0.458), symptomatic vasospasm (p = 0.097), radiological infarction (p = 0.972), or poor functional outcome at 3 months (p = 0.376).


CONCLUSIONS
The use of SSRI/SNRI prior to and during hospitalization is not associated with DCI or functional outcome in patients with aSAH.
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Jimmy B
JB
Young
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Tarun D
TD
Singh
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Alejandro A
AA
Rabinstein
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. fugate.jennifer@mayo.edu.
Jennifer E
JE
Fugate
D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects*; D000368:Aged; D002545:Brain Ischemia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage; D020301:Vasospasm, Intracranial / Q000139:chemically induced*
D018759:Adrenergic Uptake Inhibitors; D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors
Critical-care; Delayed cerebral ischemia; Selective serotonin reuptake inhibitor; Subarachnoid hemorrhage; Vasospasm