Abstract 17475: Selective Serotonin Reuptake Inhibitors Added to Antiplatelet Therapy in Patients Post Myocardial Infarction Increase the Risk of Major Bleeding
Background: Selective serotonin reuptake inhibitors (SSRIs) are often used to treat major depression in patients having suffered an acute myocardial infarction. These patients are often prescribed dual anti-platelet therapy consisting of aspirin and clopidogrel. SSRIs may have an effect on platelet inhibition and have been associated with an increased risk of major bleeding that may be aggravated in presence of anti-platelet therapy.
Objective: We assessed the hypothesis that SSRI use among patients also taking dual anti-platelet therapy post-MI would increase the bleeding risk.
Methods: We conducted a retrospective cohort study using data obtained from the Quebec health services administrative databases. Patients, 50 years of age or older, discharged alive from a hospitalization for MI between 1998 and 2007, were included at the date of discharge. Patients were separated according to whether or not they received aspirin, clopidogrel, SSRI or any combination at time of inclusion. Patients were followed until the first date of: a hospitalization for any bleeding episode, a hospitalization for MI, a discontinuation of their index study medication, death or the end of the study period.
Results: The cohort included 40,999 patients; 14,428 patients received aspirin during follow-up, 2,468 clopidogrel, 9,479 both aspirin and clopidogrel and 844 an SSRI with or without antiplatelet therapy. Cox regression models with time-dependent exposure adjusting for patient demographics and comorbidities at index date showed a higher risk of hospitalizations for major bleeding during the time patients were taking an SSRI with anti-platelet therapy versus time on antiplatelet therapy alone (hazard ratio (HR): SSRI + ASA vs. ASA 1.28; (95% CI 1.01-1.62); SSRI +ASA +clopidogrel vs. ASA 1.92; (1.33-2.76). SSRI+ASA+clopidogrel vs. ASA+clopidogrel showed a trend towards significance but was not statistically different.
Conclusions: Our results indicate that adding an SSRI to aspirin therapy increases the risk of bleeding over and beyond the risk of aspirin alone. Adding an SSRI to dual anti-platelet therapy showed a trend towards increased bleeding.
- © 2010 by American Heart Association, Inc.