Selective Serotonin Reuptake Inhibitor (SSRI) Bleeding Risk: Considerations for the Consult-Liaison Psychiatrist

• Laporte S, Chapelle C, Caillet P, Beyens MN, Bellet F, Delavenne X, et al. Bleeding risk under selective serotonin reuptake inhibitor (SSRI) antidepressants: a meta-analysis of observational studies. Pharmacol Res. 2017;118:19–32. This meta-analysis demonstrates all-sites elevated risk of bleeding from SSRI antidepressant medications.

CAS  Google Scholar 

•• Andrade C, Sandarsh S, Chethan KB, Nagesh KS. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry. 2010;71(12):1565–75. Bleeding risk from SSRI antidepressants is highest for gastrointestinal types of bleeding which is roughly double from other sites of bleeding.

Google Scholar 

Anglin R, Yuan Y, Moayyedi P, Tse F, Armstrong D, Leontiadis GI. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(6):811–9.

CAS  Google Scholar 

Nochaiwong S, Ruengorn C, Awiphan R, Chai-Adisaksopha C, Tantraworasin A, Phosuya C, et al. Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis. Ann Med. 2022;54(1):80–97.

CAS  Google Scholar 

• Jiang HY, Chen HZ, Hu XJ, Yu ZH, Yang W, Deng M, et al. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13(1):42-50.e3. The risk of upper GI bleeding may be mitigated by antiacid medication.

CAS  Google Scholar 

Shin D, Oh YH, Eom CS, Park SM. Use of selective serotonin reuptake inhibitors and risk of stroke: a systematic review and meta-analysis. J Neurol. 2014;261(4):686–95.

CAS  Google Scholar 

Singh I, Achuthan S, Chakrabarti A, Rajagopalan S, Srinivasan A, Hota D. Influence of pre-operative use of serotonergic antidepressants (SADs) on the risk of bleeding in patients undergoing different surgical interventions: a meta-analysis. Pharmacoepidemiol Drug Saf. 2015;24(3):237–45.

Google Scholar 

Jiang HY, Xu LL, Li YC, Deng M, Peng CT, Ruan B. Antidepressant use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis. J Psychiatr Res. 2016;83:160–7.

Google Scholar 

Na KS, Jung HY, Cho SJ, Cho SE. Can we recommend mirtazapine and bupropion for patients at risk for bleeding?: a systematic review and meta-analysis. J Affect Disord. 2018;225:221–6.

CAS  Google Scholar 

Troy GC. An overview of hemostasis. Vet Clin North Am Small Anim Pract. 1988;18(1):5–20.

CAS  Google Scholar 

Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci. 2007;9(1):47–59.

Google Scholar 

Lopez-Vilchez I, Diaz-Ricart M, White JG, Escolar G, Galan AM. Serotonin enhances platelet procoagulant properties and their activation induced during platelet tissue factor uptake. Cardiovasc Res. 2009;84(2):309–16.

CAS  Google Scholar 

Whitaker-Azmitia PM. The discovery of serotonin and its role in neuroscience. Neuropsychopharmacology. 1999;21(2 Suppl):2S-8S.

CAS  Google Scholar 

Erspamer V, Asero B. Identification of enteramine, the specific hormone of the enterochromaffin cell system, as 5-hydroxytryptamine. Nature. 1952;169(4306):800–1.

CAS  Google Scholar 

Li N, Wallen NH, Ladjevardi M, Hjemdahl P. Effects of serotonin on platelet activation in whole blood. Blood Coagul Fibrinolysis. 1997;8(8):517–23.

CAS  Google Scholar 

Golino P, Piscione F, Willerson JT, Cappelli-Bigazzi M, Focaccio A, Villari B, et al. Divergent effects of serotonin on coronary-artery dimensions and blood flow in patients with coronary atherosclerosis and control patients. N Engl J Med. 1991;324(10):641–8.

CAS  Google Scholar 

Pedrazza EL, Senger MR, Rico EP, Zimmermann FF, Pedrazza L, de Freitas Sarkis JJ, et al. Fluoxetine and nortriptyline affect NTPDase and 5’-nucleotidase activities in rat blood serum. Life Sci. 2007;81(15):1205–10.

CAS  Google Scholar 

Musselman DL, Tomer A, Manatunga AK, Knight BT, Porter MR, Kasey S, et al. Exaggerated platelet reactivity in major depression. Am J Psychiatry. 1996;153(10):1313–7.

CAS  Google Scholar 

Musselman DL, Marzec UM, Manatunga A, Penna S, Reemsnyder A, Knight BT, et al. Platelet reactivity in depressed patients treated with paroxetine: preliminary findings. Arch Gen Psychiatry. 2000;57(9):875–82.

CAS  Google Scholar 

Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B. Paroxetine decreases platelet serotonin storage and platelet function in human beings. Clin Pharmacol Ther. 2000;68(4):435–42.

CAS  Google Scholar 

Bashawri LA, Ahmed MA. The approach to a patient with a bleeding disorder: for the primary care physician. J Family Community Med. 2007;14(2):53–8.

Google Scholar 

Martin KA, Krahn LE, Balan V, Rosati MJ. Selective serotonin reuptake inhibitors in the context of hepatitis C infection: reexamining the risks of bleeding. J Clin Psychiatry. 2007;68(7):1024–6.

CAS  Google Scholar 

Weinrieb RM, Auriacombe M, Lynch KG, Chang KM, Lewis JD. A critical review of selective serotonin reuptake inhibitor-associated bleeding: balancing the risk of treating hepatitis C-infected patients. J Clin Psychiatry. 2003;64(12):1502–10.

Google Scholar 

Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2008;27(1):31–40.

CAS  Google Scholar 

Mort JR, Aparasu RR, Baer RK. Interaction between selective serotonin reuptake inhibitors and nonsteroidal antiinflammatory drugs: review of the literature. Pharmacotherapy. 2006;26(9):1307–13.

CAS  Google Scholar 

Johnstone C, Rich SE. Bleeding in cancer patients and its treatment: a review. Ann Palliat Med. 2018;7(2):265–73.

Google Scholar 

Angelini DE, Radivoyevitch T, McCrae KR, Khorana AA. Bleeding incidence and risk factors among cancer patients treated with anticoagulation. Am J Hematol. 2019;94(7):780–5.

CAS  Google Scholar 

Leighl NB, Bennouna J, Yi J, Moore N, Hambleton J, Hurwitz H. Bleeding events in bevacizumab-treated cancer patients who received full-dose anticoagulation and remained on study. Br J Cancer. 2011;104(3):413–8.

CAS  Google Scholar 

Narum S, Westergren T, Klemp M. Corticosteroids and risk of gastrointestinal bleeding: a systematic reivew and meta-analysis. BMJ Open. 2014;4:e004587.

Google Scholar 

Chilcot J, Spencer BW, Maple H, Mamode N. Depression and kidney transplantation. Transplantation. 2014;97(7):717–21.

Google Scholar 

Esmat Gamil M, Pirenne J, Van Malenstein H, Verhaegen M, Desschans B, Monbaliu D, et al. Risk factors for bleeding and clinical implications in patients undergoing liver transplantation. Transplant Proc. 2012;44(9):2857–60.

CAS  Google Scholar 

Nevo S, Vogelsang GB. Acute bleeding complications in patients after bone marrow transplantation. Curr Opin Hematol. 2001;8(5):319–25.

CAS  Google Scholar 

Labbate LA, Fava M, Rosenbaum JF, Arana GW. Drugs for the treatment of depression. Handbook of Psychiatric Drug Therapy Philidelphia, PA: Lippincott Williams & Wilkins; 2010. p. 54.

Anbarlou A, Rahnama MA, Atashi A, Soleimani M. Selective serotonin reuptake inhibitors may improve the efficacy of hematopoietic stem cells transplantation. J Exp Res Pharm. 2016;1(1):16–9.

Google Scholar 

Mortensen JK, Larsson H, Johnsen SP, Andersen G. Impact of prestroke selective serotonin reuptake inhibitor treatment on stroke severity and mortality. Stroke. 2014;45(7):2121–3.

CAS  Google Scholar 

Dirnagl U, Iadecola C, Moskowitz MA. Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci. 1999;22(9):391–7.

CAS  Google Scholar 

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292.

Google Scholar 

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.

CAS  Google Scholar 

Mead GE, Hsieh CF, Lee R, Kutlubaev M, Claxton A, Hankey GJ, et al. Selective serotonin reuptake inhibitors for stroke recovery: a systematic review and meta-analysis. Stroke. 2013;44(3):844–50.

Google Scholar 

Ehrenborg A. A study of the increased ris of bleeding events in patients with blood clotting disorders associated with antidepressant medication use. Open Access Master Thesis. 2016;840.

Wang M, Zeraatkar D, Obeda M, Lee M, Garcia C, Nguyen L, et al. Drug-drug interactions with warfarin: a systematic review and meta-analysis. Br J Clin Pharmacol. 2021;87(11):4051–100.

CAS  Google Scholar 

Lee MT, Park KY, Kim MS, You SH, Kang YJ, Jung SY. Concomitant use of NSAIDs or SSRIs with NOACs requires monitoring for bleeding. Yonsei Med J. 2020;61(9):741–9.

CAS  Google Scholar 

Komen JJ, Hjemdahl P, Mantel-Teeuwisse AK, Klungel OH, Wettermark B, Forslund T. Concomitant anticoagulant and antidepressant therapy in atrial fibrillation patients and risk of stroke and bleeding. Clin Pharmacol Ther. 2020;107(1):287–94.

CAS  Google Scholar 

Zeiss RHC, Gahr M. Risk of bleeding associated with antidepressant drugs: the competitive impact of antithrombotics in quantitative signal detection. Drugs-Real World Outcomes. 2021;8(4):547–54.

Google Scholar 

Schelleman H, Brensinger CM, Bilker WB, Hennessy S. Antidepressant-warfarin interaction and associated gastrointestinal bleeding risk in a case-control study. PLoS ONE. 2011;6(6):e21447.

CAS  Google Scholar 

Wallerstedt SM, Gleerup H, Sundström A, Stigendal L, Ny L. Risk of clinically relevant bleeding in warfarin-treated patients–influence of SSRI treatment. Pharmacoepidemiol Drug Saf. 2009;18(5):412–6.

CAS  Google Scholar 

Kurdyak PA, Juurlink DN, Kopp A, Herrmann N, Mamdani MM. Antidepressants, warfarin, and the risk of hemorrhage. J Clin Psychopharmacol. 2005;25(6):561–4.

CAS  Google Scholar 

Rydberg DM, Linder M, Malmström RE, Andersen M. Risk factors for severe bleeding events during warfarin treatment: the influence of sex, age, comorbidity and co-medication. Eur J Clin Pharmacol. 2020;76(6):867–76.

CAS  Google Scholar 

Ng HK, Rogala BG, Ades S, Schwartz JR, Ashikaga T, Vacek P, et al. Prospective evaluation of drug-drug interactions in ambulatory cancer patients initiated on prophylactic anticoagulation. J Oncol Pharm Pract. 2020;26(7):1637–42.

CAS  Google Scholar 

Vitry AI, Roughead EE, Ramsay EN, Preiss AK, Ryan P, Gilbert AL, et al. Major bleeding risk associated with warfarin and co-medications in the elderly population. Pharmacoepidemiol Drug Saf. 2011;20(10):1057–63.

Google Scholar 

Bleakley S. Review of the choice and use of antidepressant drugs. Prog Neurol Psychiatry. 2013;17(6):18–26.

Google Scholar 

Excellence NIfHaC. Depression in adults. Clinical Guideline CG90 2009. Available from: http://guidance.nice.org.uk/CG90. Accessed 30 Sept 2022. 

• Andrade C, Sharma E. Serotonin reuptake inhibitors and risk of abnormal bleeding. Psychiatr Clin North Am. 2016;39(3):413–26. This review demonstrates the differential effect of antidepressant class -based bleeding risk.

Google Scholar 

Meijer WE, Heerdink ER, Nolen WA, Herings RM, Leufkens HG, Egberts AC. Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Arch Intern Med. 2004;164(21):2367–70.

Google Scholar 

Schellander R, Donnerer J. Antidepressants: clinically relevant drug interactions to be considered. Pharmacology. 2010;86(4):203–15.

CAS  Google Scholar 

Ziegelstein RC, Meuchel J, Kim TJ, Latif M, Alvarez W, Dasgupta N, et al. Selective serotonin reuptake inhibitor use by patients with acute coronary syndromes. Am J Med. 2007;120(6):525–30.

CAS  Google Scholar 

Sauer WH, Berlin JA, Kimmel SE. Selective serotonin reuptake inhibitors and myocardial infarction. Circulation. 2001;104(16):1894–8.

CAS 

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