Abstract

Background: Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown.Methods: The rate of intracranial bleeding in patients with antidepressant medication was compared to patients not antidepressants in a cohort of patients with acute head injury. This association was examined by using a consecutive cohort of head trauma patients from a Finnish tertiary center emergency department (Tampere University Hospital, Tampere, Finland). All consecutive (2010–2012) adult patients (n = 2,890; median age = 58; male = 56%, CT-positive = 22%, antithrombotic medication users = 25%, antidepressant users = 10%) who underwent head CT due to head trauma in the emergency department were included.Results: Male gender, GCS <15, older age, and anticoagulation were associated with an increased risk for traumatic intracranial bleeding. There were 17.8% of patients not taking antidepressants and 18.3% of patients on an antidepressant who had traumatic intracranial bleeding (p = 0.830). Among patients who were taking antithrombotic medication, 16.6% of the patients not taking antidepressant medication, and 22.5% of the patients taking antidepressant medication, had bleeding (p = 0.239). In a regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use.Conclusions: Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage.

Highlights

  • Intracranial bleeding is the most severe and feared complication of head trauma

  • Male gender, Glasgow coma scale (GCS) < 15, older age, and anticoagulation were associated with an increased risk for traumatic intracranial bleeding

  • Traumatic intracranial hemorrhage was not associated with antidepressant use

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Summary

Introduction

Intracranial bleeding is the most severe and feared complication of head trauma. Hemorrhagic lesions may be life-threatening, require urgent neurosurgical care, and they might cause longterm disability. There is a concern that SSRIs have been linked to increased risk of bleeding, including hemorrhagic stroke [8,9,10,11,12,13,14,15,16,17,18]. This increase in bleeding risk is thought to be due to the role of serotonin in platelet aggregation, which is inhibited by SSRIs, as well as to a direct decrease in platelet adhesion to both collagen and fibrinogen [9, 19,20,21]—important processes in the initiation of hemostasis. Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown

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