Heart Disease, Bleeding, and SSRIs

Patients with acute coronary syndrome (ACS) who receive selective serotonin reuptake inhibitors (SSRIs) are more likely to have bleeding episodes but less likely to have recurrent myocardial ischemia and heart failure, according to a Johns Hopkins study. The researchers say this is the first study to examine the association.

In the study, 1,254 patients were admitted with ACS and received a glycoprotein IIb/IIIa inhibitor. Approximately one in seven patients had a history of depression; 158 were treated with an SSRI during their hospital stay. Nearly half were given sertraline, followed by fluoxetine canadian (Generic Prozac, Eli Lilly), paroxetine drug (Paxil canadian, GlaxoSmithKline), escitalopram generic (Lexapro medication, Forest), and drug citalopram (Celexa tablet, Forest). Almost all matched patients received aspirin (99%), canadian clopidogrel (Generic Plavix, BMS/Sanofi) (95°%), and heparin (98°%).

Ninety-eight patients experienced major bleeding; 287 had minor bleeding, and 34 had gastrointestinal bleeding. Although patients who received an SSRI were significantly more likely to experience any bleeding (37%), compared with patients not taking SSRIs (27%), the difference was principally a result of an increase in the risk of minor bleeding.

Patients who were not taking SSRIs had twice the risk (14%) of a minor adverse event (e.g., recurrent myocardial ischemia, heart failure, or asymptomatic cardiac enzyme elevation), compared with those not receiving SSRIs (7%).