Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke

Selective serotonin reuptake inhibitors (SSRIs) have been implicated in contributing to recovery after acute ischaemic stroke. In particular, poststroke initiation of an SSRI has been demonstrated to improve motor recovery. The role of prestroke SSRI use on functional outcomes and stroke recovery is less clear. We aimed to examine the effect of prestroke SSRI use on metrics of hospitalisation and functional recovery.

We included 4968 consecutive patients from January 2006 to June 2015 in our local Get With The Guidelines-Stroke registry in whom a preadmission drug list could be extracted from an administrative research data registry. Univariate and multivariate analyses were performed to identify predictors of functional outcomes.

On univariate analysis, among 4698 ischaemic strokes (740 SSRI users and 3948 non-users), SSRI use before acute ischaemic stroke did not impact the National Institutes of Health Stroke Scale (NIHSS) admission score, length of stay or rate of symptomatic haemorrhage. Patients using SSRIs prior to their stroke were more likely to present with weakness (57% vs 47.3%; P<0.001) and have hospitalisations complicated by pneumonia (7.6% vs 5.7%; P<0.001). Moreover, prestroke SSRI use was associated with a negative impact on ambulatory status at discharge and discharge to home. On multivariate regression analysis, SSRI use was associated with lower likelihood of discharge to home (adjusted OR 0.79, 95% CI 0.62 to 0.997, P<0.05).

SSRI use preceding an acute ischaemic stroke is associated with lower rates of discharge to home despite no significant increase in length of stay or NIHSS score.