Abstract WP166: Bleeding Risks Among Hemorrhagic Stroke Patients Started on Serotonergic Antidepressants During Subacute Recovery

Abstract

Background: Early initiation of antidepressants (ADs) are associated with improved functional recovery, but are associated with an increased risk of major bleeds among hemorrhagic stroke (HS) patients. Our objectives were to determine if increased bleeding risk remained if ADs were initiated during subacute recovery and if bleed risks were comparable between AD classes. Methods: A cohort of AD naive first time HS patients (ICD-10 codes 160-162) were identified from Electronic Medical Records of 70 large healthcare organizations (2003-2023). Patients without AD use were considered “No AD” whereas patients started on ADs during subacute recovery (i.e., at least 3 months after the indexed HS) were grouped as Selective Serotonin/Serotonin & Norepinephrine Reuptake Inhibitors (SSRI/SNRI) or “Other AD” (i.e., Mirtazapine, bupropion, trazodone, or tricyclic ADs). Baseline differences were adjusted for using 1:1 matched propensity score (PS). Outcomes included the 1-year risk of a major bleeding event (e.g., gastrointestinal/intracranial bleed or shock), recurrent HS, fall, ischemic stroke (IS) and death Results: The cohort consisted of n=257,595 patients split into 3 groups: No AD (n=250,103), SSRI/SNRI (n=4,180) or Other AD (n=3,312). Matching resulted in good covariate balance for both the SSRI/SNRI vs. No AD (n=8,250 patients) and Other AD vs. SSRI/SNRI (n=6,380 patients) comparisons. SSRI/SNRIs (vs. No AD) were associated with a 33% increase in the risk of a major bleed (RR: 1.33, 95%CI: 1.22-1.45) and significantly higher risks of recurrent HS, fall, IS and death. There were no significant differences in adverse outcomes between AD classes. Discussion: Increased risk of major bleeds and recurrent HS remains if ADs are started during subacute recovery, a time period which aligns with community-based recovery. Our findings may inform care practices of primary care providers and rehabilitation professionals to decrease preventable adverse outcomes.