Abstract W P139: Differential Impact of Preadmission Selective Serotonin Reuptake Inhibitor Treatment on Stroke Outcomes Among Ischemic and Hemorrhagic Stroke Patients? A Nationwide Propensity Score-Matched Follow-Up Study

Abstract

Introduction: SSRIs are widely used for treating post-stroke depression and pathological crying and appear to have antithrombotic effects that may increase the risk of bleeding. Increasing evidence further suggests a neuroprotective effect in stroke, however clinical data are sparse. Aim and hypothesis: We aimed to examine the implications of pre-admission SSRI use in patients with ischemic and hemorrhagic stroke. We hypothesized a neuroprotective and antithrombotic effect leading to less severe strokes and decreased 30-day mortality among the ischemic strokes, and a possible reverse effect among the hemorrhagic strokes. Methods: We did a nationwide registry-based follow-up study among ischemic and hemorrhagic stroke patients in Denmark between 2003 and 2011. We identified 4348 pre-admission SSRI users (556 hemorrhagic strokes) and 4348 propensity score-matched non-users in the Danish Stroke Registry. Multiple conditional logistic regression was used to compute odds ratios (OR) of severe stroke (as measured on the Scandinavian Stroke Scale) and death within 30 days after stroke. Analyses were repeated after excluding patients with hemorrhagic stroke. Results: For the stroke types combined, pre-admission SSRI use was associated with a higher risk of severe stroke (adjusted OR, 1.12; CI, 1.00-1.25) and a non-significantly higher risk of death within 30 days (adjusted OR, 1.27; CI, 0.73-2.19). In contrast, no statistically significant difference in risk of severe stroke (adjusted OR, 1.06; CI, 0.92-1.21) or death within 30 days (adjusted OR, 0.81; CI, 0.38-1.77) was found between pre-admission SSRI-users and non-users after excluding patients with hemorrhagic stroke. Conclusion: Our results suggest that pre-admission SSRI use may be associated with a higher risk of severe stroke and case-fatality in patients with hemorrhagic stroke, but not in patients with ischemic stroke. Further studies are warranted to explore the possible neuroprotective and hemorrhagic effects of SSRI treatment in patients admitted with acute stroke.