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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