Serotonergic Antidepressants Increase Bleeding Risk In Heart Failure Patients With Left Ventricular Assist Device: A Systematic Review And Meta-analysis

Introduction

Serotonergic antidepressants (SAs) are the primary pharmacological treatment for depressive symptoms in patients with heart failure (HF). However, concerns have been raised about the potential for bleeding events in patients with left ventricular assist devices (LVADs).

Hypothesis

This systematic review and meta-analysis aim to quantify the bleeding risk in patients with heart failure with LVADs who are taking serotonergic antidepressants.

Methods

A systematic review and meta-analysis were conducted on clinical trials retrieved from Scopus, Cochrane, PubMed, and Web of Science databases from their inception until March 2024. Studies reporting on the association of bleeding events with the use of SSRI/SNRI therapy were included. The primary outcome was the occurrence of any bleeding events. Data from the studies were pooled using RevMan V5.4, and odds ratios (OR) and confidence intervals (CI) were calculated for the outcome.

Results

The meta-analysis included four studies, mainly observational retrospective studies, as the search yielded no randomized controlled trials, with a total of 1006 participants. Among them, 183 of the 408 (44.8%) patients taking SSRIs/SNRIs experienced bleeding, compared to 207 of the 598 (34.6%) patients not taking SSRIs/SNRIs. The increased risk of bleeding was statistically significant (P=0.005), with an odds ratio of 1.45 [95% CI: 1.12, 1.89], favoring the control group (not taking SSRIs/SNRIs). The limitation of this study is the non-availability of randomized data. Also, the bleeding outcome differs across the studies, with two studies reporting the occurrence of any bleeding, two studies reporting gastrointestinal bleeding, and one study reporting hospitalization for any bleeding.

Conclusion

The findings suggest that the rate of bleeding is higher in patients with heart failure with LVADs who are treated with serotonergic antidepressants compared to those who are not treated with serotonergic antidepressants. This underscores the need for careful monitoring when prescribing these medications. However, further research is needed to confirm the findings and identify the optimal serotonergic antidepressant associated with less or no bleeding.