Abstract WMP84: The Impact of Pre-Morbid Antidepressant Exposure on the Risk of Intracerebral Hemorrhage: The Florida Stroke Registry

Abstract

Antidepressants (AD), particularly selective serotonin reuptake inhibitors (SSRIs), are amongst the most frequently prescribed medications. Concerns have been raised regarding their potential increased risk of bleeding complications including intracerebral hemorrhage (ICH) as they are known to affect platelet function. In the large Florida Stroke Registry (FSR), we sought to determine if pre-morbid use of AD impacted the risk of ICH Methods: Data collected from Jan 2010-Jun 2023 in FSR, GWTG statewide stroke registry comprised of 170 hospitals in the state of Florida was used to identify ischemic (IS) and hemorrhagic stroke cases with and without prior use of AD. Multivariate regression with generalized estimating equations, were used to determine whether premorbid-AD use was associated with an increased risk of ICH vs. ischemic stroke Results: A total of 219,558 stroke cases were identified (mean age 70.26±14.45; 52% male), among those 14% had pre-morbid AD use (age 72.13±13.23, 39% male). Patients on pre-morbid AD (vs no AD) were more likely White (75% vs. 62%) female (61% vs. 46%), with higher rates of vascular risk factors [(HTN (83%), DM (40%), HLD (61%), prior TIA (39%)]. The percentage of ICH was 11% and 14% amongst AD users and non-AD users respectively. In a multivariate model adjusting by multiple covariates, prior use of AD was not associated with an increased likelihood of presenting with ICH as opposed to IS (OR=0.72, 0.42-1.21). In the sensitivity analysis of subgroups of patients with data regarding the class of AD (SSRIs, Non-SSRIs) (n=657) or prior antiplatelet or anticoagulant therapies (n=740) premorbid SSRI use (vs no AD use) was not associated with increase ICH risk (OR=1.39, 95%CI 0.81-2.38 and OR=0.84, 0.64-1.10) Discussion In this large registry-based study we did not find an association between prior use of AD and increased risk of ICH as opposed to IS. Additionally, our findings were consistent among stroke patients with prior use of either antiplatelet or anticoagulants. These findings challenge the prevailing literature notion that AD, particularly SSRIs are linked to an increased risk of hemorrhages of all type. However, clinicians should consider individual patient's presentation, comorbidities and preferences when prescribing AD