The use of selective serotonin receptor inhibitors (SSRIs) is not associated with increased risk of endoscopy‐refractory bleeding, rebleeding or mortality in peptic ulcer bleeding

Summary Background Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRIs is often temporarily with...

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Published in:Alimentary pharmacology & therapeutics 2017-08, Vol.46 (3), p.355-363
Main Authors: Laursen, S. B., Leontiadis, G. I., Stanley, A. J., Hallas, J., Schaffalitzky de Muckadell, O. B.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Bleeding
Cohort Studies
Denmark
Endoscopy
Endoscopy - methods
Female
Health risk assessment
Hemorrhage
Hemostasis, Endoscopic - methods
Hospitalization
Humans
Inhibitors
Male
Middle Aged
Mortality
Odds Ratio
Peptic Ulcer Hemorrhage - epidemiology
Peptic Ulcer Hemorrhage - mortality
Platelet aggregation
Risk
Risk Factors
Sensitivity
Serotonin
Serotonin Uptake Inhibitors - administration & dosage
Serotonin Uptake Inhibitors - adverse effects
Ulcers
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Summary:Summary Background Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRIs is often temporarily withheld in patients with peptic ulcer bleeding. However, abrupt discontinuation of SSRIs is associated with development of withdrawal symptoms in one‐third of patients. Further data are needed to clarify whether treatment with SSRIs is associated with poor outcomes, which would support temporary discontinuation of treatment. Aim To identify if treatment with SSRIs is associated with increased risk of: (1) endoscopy‐refractory bleeding, (2) rebleeding or (3) 30‐day mortality due to peptic ulcer bleeding. Methods A nationwide cohort study. Analyses were performed on prospectively collected data on consecutive patients admitted to hospital with peptic ulcer bleeding in Denmark in the period 2006‐2014. Logistic regression analyses were used to investigate the association between treatment with SSRIs and outcome following adjustment for pre‐defined confounders. Sensitivity and subgroup analyses were performed to evaluate the validity of the findings. Results A total of 14 343 patients were included. Following adjustment, treatment with SSRIs was not associated with increased risk of endoscopy‐refractory bleeding (odds ratio [OR] [95% Confidence Interval (CI)]: 1.03 [0.79‐1.33]), rebleeding (OR [95% CI]: 0.96 [0.83‐1.11]) or 30‐day mortality (OR [95% CI]: 1.01 [0.85‐1.19]. These findings were supported by sensitivity and subgroup analyses. Conclusions According to our data, treatment with SSRIs does not influence the risk of endoscopy‐refractory bleeding, rebleeding or 30‐day mortality in peptic ulcer bleeding. Linked ContentThis article is linked to Vakil paper. To view this article visit https://doi.org/10.1111/apt.14199.
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.14153