Abstract 23: Selective serotonin reuptake inhibitors in acute ischemic stroke patients during inpatient rehabilitation

Abstract

Objective: To examine the safety of selective serotonin reuptake inhibitor (SSRI) antidepressants after stroke and their effect on rehabilitation. Design: Chart review study. Setting: Community-based rehabilitation hospital. Participants: 147 ischemic stroke survivors admitted between August 1, 2001 and May 31, 2002. Interventions: Not applicable. Main Outcome Measures: Evidence of SSRI-related adverse events and FIM™ instrument score. Results: 85 patients received an SSRI for depressive symptoms. +SSRI and −SSRI patients did not differ in age, gender, length of stay (LOS) in the acute care hospital (9.5±7.6d vs 8.2±5.9d, P=.065), or change FIM score (22.1±13.2 vs 20.5±16.2, P=0.5). +SSRI patients had longer LOS in rehabilitation (20.1±9.1d vs 13.7±8.0d, P<.0001), lower FIM score at admission (55.6±20.7 vs 73.8±20.2, P<.0001), and lower FIM efficiency (1.2±1.0 vs 1.8±1.5, P=.01). 16 +SSRI (18.8%) and 6 −SSRI (9.7%) patients experienced 1 or more bleeding episodes, most commonly: gastrointestinal bleed (including occult bleeding), bleeding from a recently inserted gastrostomy tube or pacemaker, nose bleeds, hematuria, or easy bruising. Only 1 +SSRI and 1 −SSRI patient with bleeding required acute medical care. No hemorrhagic transformations of ischemic strokes were noted. Altered mental status occurred in 2 +SSRI and 6 −SSRI patients. Worsening neurologic symptoms occurred only in 4 −SSRI patients. All patients with abnormal bleeding received ≥1 anticoagulant or antiplatelet agents (n=21) or had recently undergone a surgical procedure (renal stent placement, n=1). Conclusions: Bleeding complications were more common in +SSRI patients despite equivalent anticoagulant and antiplatelet treatment, emphasizing the importance of monitoring for bleeding complications during SSRI treatment. +SSRI patients experienced a similar improvement in FIM score, but had lower FIM efficiency, possibly reflecting the underlying effect of depressive symptoms.