Impact of Selective Serotonin Reuptake Inhibitors on Bleeding Rates in HeartMate 3 Left Ventricular Assist Device...

Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) therapy have been associated with increased bleeding risk in left ventricular assist device (LVAD) patients receiving warfarin and aspirin. In 2019, our institution stopped routinely prescribing aspirin to patients with a HeartMate 3 (HM3) LVAD.

This single-center retrospective cohort study evaluates the risk of major bleeding with SSRI/SNRI use in HM3 LVAD patients not receiving aspirin. The primary outcome was the incidence of a major bleeding event, defined as an INTERMACS type 2, 3a, 3b, or 5 bleed, and was analyzed using a multivariable Cox proportional hazard regression model with age, gender, chronic kidney disease stage 3-5, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, history of a gastrointestinal bleed, and warfarin time in therapeutic range as covariates.

Of the included 101 patients, 60 (59%) received an SSRI/SNRI. A major bleeding event occurred in 11 (18%) patients in the SSRI/SNRI group and 6 (15%) patients in the non-SSRI/SNRI group, which was not significantly different following multivariate adjustment (HR 1.04, 95% CI 0.32-3.37, p = 0.43).

Further studies in larger populations are needed to confirm the lack of association between SSRI/SNRI use and bleeding in HM3 LVAD patients not receiving aspirin.