Selective serotonin reuptake inhibitors and bleeding risk in patients undergoing PCI on dual antiplatelet therapy: a...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Mood disorders are common in coronary artery disease (CAD) patients.
• Selective serotonin reuptake inhibitors (SSRIs) may increase bleeding risk, especially with dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI).
• Limited data exist on SSRI use and bleeding in PCI populations.

Purpose of the Study:

• To investigate the association between SSRI use and bleeding risk in patients undergoing PCI with DAPT.
• To evaluate the impact of SSRIs on major bleeding, intracranial hemorrhage (ICH), and gastrointestinal bleeding (GIB) in this population.

Main Methods:

• Retrospective cohort study using the TriNetX Global Collaborative Network (29,973 PCI patients on DAPT).
• Compared 3,023 SSRI users with 3,023 propensity-score matched non-users.
• Assessed one-year incidence of major bleeding (including ICH, GIB, transfusion) and ischemic outcomes.

Main Results:

• SSRI users had a significantly higher risk of major bleeding (14.0% vs 11.3%; HR 1.28).
• Increased risk observed for intracranial hemorrhage (1.2% vs 0.7%; HR 1.73) and gastrointestinal bleeding (7.4% vs 5.6%; HR 1.34).
• No significant difference in all-cause mortality or ischemic outcomes between groups.

Conclusions:

• Concomitant SSRI therapy with DAPT post-PCI is associated with increased bleeding risk, particularly ICH and GIB.
• The interaction does not appear to increase ischemic event rates.
• Clinical awareness and bleeding risk mitigation strategies are crucial, especially in high-risk patients.