Abstract
We evaluated the effect of SSRI treatment on platelet aggregation in patients with ischaemic stroke and included patients from the randomized double-blind controlled study of citalopram in acute ischaemic stroke (TALOS). Patients on clopidogrel were included 6 months after acute ischaemic stroke. Platelet parameters, including P2Y12 platelet reactivity using the VerifyNow System, were measured at the last day of study treatment and repeated after a 14-day wash-out period. A total of 60 patients were included (n = 32 randomized to citalopram). Platelet aggregation levels did not differ between the citalopram group (mean 116, 95% CI 89 to 143) and the placebo group (mean 136, 95% CI 109 to 163) (On-treatment, p = 0.14). Similarly, there was no significant change in platelet aggregation in the citalopram group from on-treatment to post-treatment (mean difference 2.0; 95% CI −18 to 14). Platelet count, size and turnover were not affected by SSRI treatment. In conclusion, SSRI therapy did not lead to statistically significant inhibition of platelet aggregation in ischaemic stroke patients treated with clopidogrel.
Highlights
We evaluated the effect of SSRI treatment on platelet aggregation in patients with ischaemic stroke and included patients from the randomized double-blind controlled study of citalopram in acute ischaemic stroke (TALOS)
The median time from intake of study medication to blood sampling did not differ between groups: 5.1 h in the citalopram group and 4.8 h in the placebo group
adenosine diphosphate (ADP)-induced platelet aggregation (PRU) levels did not differ between the citalopram group and the placebo group when comparing patients during treatment (Table 1)
Summary
We evaluated the effect of SSRI treatment on platelet aggregation in patients with ischaemic stroke and included patients from the randomized double-blind controlled study of citalopram in acute ischaemic stroke (TALOS). SSRI therapy did not lead to statistically significant inhibition of platelet aggregation in ischaemic stroke patients treated with clopidogrel. This inhibits platelet-mediated haemostasis and may reduce the risk of cardiovascular events[5,6] This is a predefined substudy (Ethical committee approval no 1-10-72-183-13, see supplementum in7) of the TALOS trial testing the SSRI citalopram in non-depressed patients with acute ischaemic stroke[7,8]. We compared platelet aggregation levels in patients with ischaemic stroke treated with clopidogrel in addition to citalopram vs placebo. That platelet aggregation would increase in patients randomized to citalopram when measurements were repeated after a wash-out period
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