Serotonin-based meds linked to lower risk of bleeding events 1 year post stroke

Key takeaways:

• Early use of SSRI/SNRIs was not associated with risk of bleeding in patients.
• However, there was increased risk of bleeding with antidepressants for those on dual antiplatelet therapy.

Treatment with selective serotonin/serotonin-norepinephrine reuptake inhibitors after ischemic stroke was associated with low risk of bleeding events at 1 year, according to a presenter at the International Stroke Conference.

“Selective serotonin/serotonin-norepinephrine reuptake inhibitors are associated with improved stroke recovery,” said lead study author Kent P. Simmonds, DO, PhD, a resident in the department of physical medicine and rehabilitation at the Peter O’Donnell Jr. Brain Institute at the University of Texas Southwestern Medical Center. “Some clinicians withhold SSRI/SNRIs over bleeding risk concerns.”

Simmonds and colleagues aimed to quantify the association between early initiation of SSRI/SNRIs and adverse bleeding events among patients with acute ischemic stroke, determine bleeding risks among those given anticoagulation (AC) or dual antiplatelet therapy (DAPT) and evaluate bleeding risks among classes of antidepressants (AD).

Their study drew data from electronic medical records of 70 health care organizations between 2003 and 2023 to yield 666,150 individuals who were deemed “medication naïve” first-time IS patients. Patients without ADs were considered “No AD” (n = 607,278).

Patients included for analysis who started on ADs within 3 months of an indexed stroke were classified as "SSRI/SNRI" (n = 35,631) or “Other AD” (ie, mirtazapine, bupropion, trazodone or tricyclic AD; n = 23,241).

The primary outcome was risk of major bleeding events at 1 year post index stroke, with secondary outcomes including hemorrhagic stroke (HS), fall and death. Baseline differences were adjusted by utilizing matched propensity scores on a 1:1 basis.

According to results, early use of SSRI/SNRIs (compared with No ADs) was not associated with an increased risk of a major bleed for the whole study population (n = 35,557 matched pairs) or among patients on AC (n = 7,672 matched pairs).

Researchers found that concurrent use of SSRI/SNRIs and DAPT was associated with a 29% increased risk of HS (RR = 1.29; 95% CI: 1.11-1.5, n = 8,381 matched pairs), while for those on ADs, bleed risks were higher for use of “Other ADs” compared with "SSRI/SNRIs" (n = 21,810 matched pairs).

“Maximizing rehabilitation early after stroke is essential because recovery is somewhat time dependent and most functional gains occur during the first few months after,” Simmonds said in a related release. “Future research should investigate the risk of bleeding associated with use of antidepressant and anxiety medications among patients with hemorrhagic or bleeding stroke.”

Reference:

• Two common types of antidepressants were safe for most stroke survivors. https://newsroom.heart.org/news/2-common-types-of-antidepressants-were-safe-for-most-stroke-survivors?preview=916f&preview_mode=True. Published Feb. 1, 2024. Accessed Feb. 8, 2024.