- Selective serotonin reuptake inhibitors (SSRIs) are tied to increased bleeding risk.
- These authors have surveyed relevant meta-analyses to develop recommendations for managing and reducing the risk.
Why this matters
- Antidepressants are commonly prescribed, and SSRIs in particular may affect platelets.
- Nonsystematic review of 9 meta-analyses of bleeding risk with SSRIs and 1 meta-analysis of bleeding risk with mirtazapine (Remeron) and bupropion (Zyban).
- Funding: None.
- The risk for any bleed was heightened with SSRI use: OR, 1.41 (P<.001>
- The risk was particularly high for gastrointestinal bleeding: OR, 1.55 (95% CI, 1.32-1.82).
- Risk was lower for intracranial hemorrhage: OR, 1.16 (95% CI, 1.01-1.33).
- One meta-analysis showed increased risk for brain hemorrhage associated with SSRI use: OR, 1.61 (95% CI, 1.04-2.51).
- Another showed greater risk for postpartum hemorrhage: OR, 1.32 (P<.001>
- With respect to concomitant drugs, the researchers found increased risk associated with use of NSAIDs, with ORs ranging from 3.17 to 10.9.
- When prescribing SSRIs, clinicians must ask patients about over-the-counter drug use, especially NSAIDs.
- For at-risk patients, education about bleeding risk is critical.
- Bupropion may be a good choice for at-risk patients.
- Proton-pump inhibitors may reduce bleeding risk, but their adverse effects must be considered.