1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

SSRIs May Increase GI Bleeding Risk

Several case reports have suggested an association between selective serotonin reuptake inhibitors (SSRIs) and gastrointestinal bleeding. Because there may be a physiologic explanation for this relation -- serotonin depletion of platelets -- Spanish investigators performed this case-control study to determine bleeding risk.

Researchers identified 1651 cases of upper GI bleeding and 248 cases of perforated ulcers from a general practice database. They compared these patients with 10,000 controls matched for age, sex, and case year. Current exposures to SSRIs were found in 3.1 percent of cases and 1.0 percent of controls, for a relative risk of 3.0 after controlling for confounders. There was no association with perforated ulcers. A crude incidence of 1 case per 1300 patients (representing 8000 prescriptions) was estimated. Concurrent use of SSRIs and nonsteroidal anti-inflammatory drugs increased the relative risk for GI bleeding to 15.6.

Comment: The reported effect, although significant, is small -- about equivalent to the use of low-dose ibuprofen. An editorialist suggests that these findings shouldn't change prescribing patterns, but also notes that caution is warranted in the simultaneous use of SSRIs and NSAIDs.

— KI Marton

Published in Journal Watch General Medicine November 19, 1999

Citation(s):

de Abajo FJ et al. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: Population based case-control study. BMJ 1999 Oct 23 319 1106-1110.

• Original article (Subscription may be required)
• Medline abstract (Free)

Li Wan Po A. Antidepressants and upper gastrointestinal bleeding. BMJ 1999 Oct 23 319 1081-1082.

• Original article (Subscription may be required)
• Medline abstract (Free)