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Published on: October 15, 2021
Serotonin reuptake inhibition and intracerebral hemorrhage risk after ischemic stroke: A multicenter retrospective
Sean Y Li1, Aritra Nag1, David Ben-Israel2
1Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Selective serotonin reuptake inhibitors (SRIs) increase intracerebral hemorrhage risk in ischemic stroke survivors. Careful risk-benefit assessment is crucial when prescribing these antidepressants post-stroke.
Area of Science:
- Neurology
- Pharmacology
- Clinical Medicine
Background:
- Selective serotonin reuptake inhibitors (SRIs) are commonly prescribed for post-stroke depression.
- SRIs possess antiplatelet effects, potentially elevating intracerebral hemorrhage (ICH) risk in ischemic stroke patients.
Purpose of the Study:
- To investigate the association between SRI use and the risk of non-traumatic ICH in adult patients following an ischemic stroke.
Main Methods:
- Retrospective cohort study using the TriNetX database.
- Propensity score matching (PSM) to compare patients prescribed SRIs versus those not prescribed SRIs within 3 months post-stroke.
- Primary outcome: non-traumatic ICH within 3 years.
Main Results:
- SRI use was associated with a significantly higher incidence of ICH (HR: 1.48 [1.29, 1.71]).
- Increased risk of ICH persisted after excluding patients with substance use disorders.
- Gastrointestinal bleeding and mortality rates were also elevated in the SRI group.
Conclusions:
- SRI prescription following ischemic stroke is linked to an increased risk of ICH.
- Findings suggest a need for careful risk-benefit evaluation of SRIs in this patient population.
- Further prospective studies are warranted for clinical validation.
Background:
Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SRIs) are common medications used in the management of post-stroke depression. However, their antiplatelet effects may increase the risk of intracerebral hemorrhage (ICH) in patients already at elevated risk following ischemic stroke.
Methods:
A retrospective cohort study of adults with an ischemic stroke encounter diagnosis was conducted using the TriNetX database. Patients prescribed an SRI within 1 day to 3 months post-stroke were compared with patients without SRI prescriptions. Demographic, clinical, laboratory, and medication covariates were adjusted between the two cohorts using 1:1 propensity score matching (PSM). The primary outcome was nontraumatic ICH within 3 years. A p-value < 0.01 and 95 % confidence intervals (CIs) < 0.9 and > 1.1 were considered statistically significant.
Results:
After PSM, 42,310 patients were included in the SRI cohort and the non-SRI cohort. The overall incidence of ICH was significantly more frequent in the SRI group (HR [95 % CI]: 1.48 [1.29, 1.71]). ICH risk remained significant after excluding patients with alcohol or substance use disorders in a secondary analysis. GI bleeding events and mortality rates were also higher in the SRI cohort (HR [95 % CI]: 1.37 [1.27, 1.48] and HR [95 % CI]: 1.54 [1.47, 1.61], respectively) when compared to the non-SRI cohort.
Conclusions:
SRI use following ischemic stroke was associated with an increased risk of ICH. These findings highlight the potential for cautious risk-benefit assessment when prescribing SRIs post-stroke and can serve as the basis for prospective studies with detailed clinical validation.
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