SSRI With Antiplatelet Therapy Ups Post-MI Bleeding Risk

Selective serotonin reuptake inhibitors with ASA tied to higher bleeding risk than ASA alone

THURSDAY, Sept. 29 (HealthDay News) -- Combined use of selective serotonin reuptake inhibitors (SSRIs) with antiplatelet agents, including acetylsalicylic acid (ASA), clopidogrel, or both, is associated with an increased risk of bleeding following acute myocardial infarction (MI), according to a study published online Sept. 26 in CMAJ, the journal of the Canadian Medical Association.

Christopher Labos M.D., C.M., from McGill University in Montreal, and colleagues retrospectively investigated the risk of bleeding associated with the use of SSRIs when combined with antiplatelet therapy in 27,058 patients (aged ≥50 years) with a primary diagnosis of acute MI between 1998 and 2007. Patients were separated into six categories according to medications received: ASA; clopidogrel; ASA and clopidogrel; ASA and an SSRI; ASA, clopidogrel, and an SSRI; and clopidogrel and an SSRI. Data were collected from health services administrative databases. Follow-up was conducted until hospital admission for a bleeding episode or recurrent acute MI, death, or study-period termination.

The investigators found that, compared with ASA alone, use of ASA with SSRI, and ASA with SSRI and clopidogrel was associated with an increased risk of bleeding (hazard ratio [HR], 1.42 and 2.35, respectively). Combined use of SSRI and dual antiplatelet therapy (ASA and clopidogrel) correlated with a higher risk of bleeding, compared to the use of dual antiplatelet therapy alone (HR, 1.57).

"Clinicians must weigh the benefits of SSRI therapy against the risk of bleeding in patients with major depression following acute myocardial infarction," the authors write.

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