Healio
Healio
February 17, 2014
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Study: Use of warfarin combined with SSRIs, SNRIs increases mortality risk after cerebral hemorrhage

Patients who took warfarin in combination with selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors had an increased risk of mortality after a primary intercerebral hemorrhage, according to a study from Finnish researchers.

“We observed that the use of serotonin-modulating antidepressants together with warfarin, compared with warfarin alone, seems to be associated with increased case fatality among patients with [primary intracerebral hemorrhage] PICH,” Pekka Löppönen, MD, and colleagues wrote in the study. “According to this population-based study, the use of serotonin-modulating antidepressants in patients already taking warfarin should be carefully considered or even avoided, until its safety is proven by larger population studies.”

Löppönen and colleagues performed a population-based retrospective study of 176 patients in Northern Ostrobothnia, Finland, who developed a PICH between 1993 and 2008. Of these patients, 19 patients were taking warfarin in combination with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and 17 patients were taking warfarin combined with aspirin, according to the abstract.

The researchers found patients taking warfarin in combination with aspirin had a case failure rate of 58.8%, while patients who were taking warfarin in combination with SSRIs and SNRIs had a case failure rate of 78.9%. Patients taking warfarin alone had a case failure rate of 50.7%, according to the abstract.

“An increased bleeding risk should be taken into account if surgical hematoma evacuation is planned in these patients,” the researchers wrote. — by Jeff Craven

Disclosure: The authors have no relevant financial disclosures.

Sources/Disclosures

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Source:

Löppönen P. J Neurosurg. 2014;doi:10.3171/2013.12.JNS131898.