SSRI Antidepressants, Anti-Clotting Drugs May Up Bleeding Risk

<"">Selective serotonin reuptake inhibitor (SSRI) antidepressants might not be a good choice for heart attack patients who are also taking blood thinners like <"">Plavix. Such drug combos may increase bleeding risks compared to those prescribed anti-clotting therapies alone, according to a study published yesterday in the Canadian Medical Association Journal.

SSRI antidepressants include drugs like Prozac, Luvox, Paxil, Celexa and Zoloft. According to a report from Med Page Today, about 20 percent of heart disease patients experience depression, and most are treated with an SSRI.

Many heart attack patients are also prescribed antiplatelet therapy, such as Plavix or aspirin, or a combination of the two, to prevent a reoccurrence.

This new study was conducted by researchers at McGill University in Montreal, Canada.

The research team looked at more than 27,000 heart attack patients, aged 50 and older. Of those, 14,426 received aspirin; 2,467 Plavix; 9,475 both aspirin and Plavix (dual antiplatelet therapy); 406 aspirin and an SSRI; 239 aspirin, Plavix and an SSRI; and 45 Plavix and an SSRI.

The study found that Patients taking aspirin or Plavix alone had a similar risk of bleeding.

Those taking aspirin with an SSRI had a 42% increased risk of bleeding compared with taking aspirin alone. The risk increased to 49% when patients were taking an SSRI with both aspirin and Plavix compared with aspirin alone. And when patients added an SSRI on top of the aspirin/Plavix combo, the risk of bleeding was 57% higher compared with dual antiplatelet therapy alone.

Women and patients who underwent angioplasty faced the lowest risk of bleeding, the study found.

Bleeding events counted in the study included bleeding stomach ulcers, a hemorrhagic stroke or other bleeds that necessitate hospital care.

The study authors concluded that doctors should be cautious when prescribing SSRIs to heart attack patients on an anti-clotting therapy like Plavix.

“Ultimately, clinicians must weigh the benefits of SSRI therapy against the risk of bleeding in patients with major depression following acute myocardial infarction,” the researchers wrote in a journal news release.

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