Risks for bleeding were increased with selective serotonin reuptake inhibitors but mitigated by proton-pump inhibitors.

Patients who receive selective serotonin reuptake inhibitors (SSRIs) have elevated risks for upper gastrointestinal bleeding (UGIB), presumably from the effect of SSRIs on platelet aggregation. Nonsteroidal anti-inflammatory drugs (NSAIDs) also elevate the risk for UGIB, and proton-pump inhibitors (PPIs) are often used to mitigate that risk. Whether PPIs would be similarly protective in patients receiving SSRIs has been unclear.

To evaluate the risk for UGIB in patients who received SSRIs alone or in combination with NSAIDs or PPIs, Canadian investigators performed a population-based, case-control study using the Manitoba Population Health Research Data Repository. The investigators analyzed 1552 patients admitted to hospitals for UGIB and 68,590 nonbleeding controls matched by age, sex, and comorbidities.

Compared with people in the study who received no drugs, patients who received either SSRIs or NSAIDs had elevated risks for UGIB (odds ratio, 1.43; 95% CI, 1.09–1.89; and OR, 2.62; 95% CI, 2.26–3.03, respectively). However, combining an NSAID with an SSRI did not further elevate the risk (OR, 1.21; 95% CI, 0.76–1.93). Compared with patients who received only SSRIs, patients who received concomitant PPIs had significantly reduced risks for UGIB (OR, 0.39; 95% CI, 0.16–0.94).

Comment: This study illustrates the benefits of concomitant PPIs in patients at high risk for UGIB. The data also suggest that these same high-risk patients might benefit from PPI therapy if they are receiving SSRIs.

Published in Journal Watch Gastroenterology July 24, 2009

Citation:
Targownik LE et al. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding. Am J Gastroenterol 2009 Jun; 104:1475. [Medline® Abstract]