Clopidogrel dose responsiveness, poststroke survival and SSRI treatment, and discontinuation of physician–pharmacist intervention

Abstract

especially if the patient has a history of depression or was taking an SSRI before the stroke. The association of depres- sion diagnosis and pre- and/or poststroke selective serotonin reuptake inhibitor (SSRI) treatment with survival (days) was examined. Depression treatment and diagnosis data for 6 months before and 1 year after the stroke index date were abstracted for a retrospective cohort (n = 790). Of veterans, 12% died 1 year or less after the stroke and an additional 26% died within 7 years. Veterans treat- ed with an SSRI only before their stroke were three times more likely to die (haz- ard ratio 3.12 (95% CI 1.60-6.09)). SSRI treatment before and after the stroke was protective compared with no SSRI for 1 year after the stroke (0.31 (0.11-0.86)). However, SSRI treatment before and af- ter stroke conferred greater risk by the end of 7 years (1.36 (1.00-1.87)). Implications. Poststroke SSRI treat- ment was associated with longer survival. Possible reasons include undiagnosed or continuing depression with no opportu- nity to benefit if untreated. These findings provide additional evidence for a random- ized trial of poststroke treatment prophy- laxis.