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
Summary
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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