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Heart patients on depression meds may risk internal bleeding

lab work

Heart attack patients taking selective serotonin reuptake inhibitors (SSRIs) in combination with antiplatelet therapy are at a higher risk of bleeding than patients taking the antiplatelet therapy alone. Antiplatelet therapies include Acetylsalicylic acid (ASA), clopidogrel or both referred to as dual antiplatelet therapy. The study has been published in the Canadian Medical Association Journal.

For patients who have had heart attacks, antiplatelet therapy is a common approach to preventative treatment. The drugs are proven to reduce subsequent heart attacks. For many of these patients, depression is also a part of their lives. One of the side effects of ASA is that when taken in combination with certain other drugs, like SSRIs, bleeding is increased.

The study published in CMAJ looked at about twenty-seven thousand patients aged 50 and older between 1997 and 2007. More than half were taking the ASA alone and about 3% were taking SSRIs combined with ASAs. Researchers found that although ASA and clopidogrel taken individually have a similar risk of bleeding, combining an SSRI with ASA increased the risk by 42%, and combining SSRI use with dual antiplatelet therapy increased the risk by 57%. Women seemed to fare better with a decreased risk of bleeding. Patients who had angioplasty as a treatment also tested better.

Types of bleeding included gastrointestinal bleeding, hemorrhagic stroke or other bleeding that required hospital admission or were reported as occurring in the hospital during treatment. “Ultimately, clinicians must weigh the benefits of SSRI therapy against the risk of bleeding in patients with major depression following acute myocardial infarction,” writes the authors. Physicians need to be careful when combining these drugs. Patients need to know there is risk.

Source: CMAJ, ScienceDaily

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