What question did this study set out to answer?

Explore the interaction between SSRI use and gastrointestinal bleeding risk in aspirin users.

January 10, 2026Journal of Psychiatric Research0 citations

Selective serotonin re-uptake inhibitor use and risk of gastrointestinal bleeding in aspirin users

Q: What does this research mean for the field?

SSRIs increase the risk of gastrointestinal bleeding in aspirin users, with an adjusted HR of 1.27, and paroxetine users at a significantly higher risk (HR 1.73). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

YHYihui HeFujian Medical University XZXin ZhangFujian Medical University QLQixuan LuoSun Yat-sen University

Key Result

SSRIs increased the risk of gastrointestinal bleeding in aspirin users, with an adjusted HR of 1.27, and paroxetine users at a significantly higher risk (HR 1.73).

Key Points

Explore the interaction between SSRI use and gastrointestinal bleeding risk in aspirin users.
Conducted a prospective cohort study with 12,712 new aspirin users from the UK Biobank.
Retrieved prescription data for aspirin and SSRIs from primary care records.
Analyzed GI bleeding incidents through hospital inpatient admissions.
Used a competing risk model to calculate hazard ratios and confidence intervals.
Incidence rate of GI bleeding was 7.44 per 1000 person-years in SSRIs users vs. 4.99 in non-SSRIs users.
Significant positive association observed between SSRIs use and GI bleeding risk (Adjusted HR, 1.27).
Higher risk noted in young adults, females, those with a history of GI bleeding, or using PPIs.
Paroxetine users showed the highest risk of GI bleeding (Adjusted HR, 1.73).

Structured PICO

Does SSRI use increase the risk of gastrointestinal bleeding in aspirin users with a history of ischemic cardiovascular disease?

Population

12,712 new aspirin users with a history of ischemic cardiovascular disease from the UK Biobank.

Intervention

Selective serotonin reuptake inhibitors (SSRIs) use

Comparator

Non-SSRI use (aspirin therapy alone)

Outcome

Gastrointestinal (GI) bleeding requiring hospital inpatient admissionsafety

The addition of SSRIs, particularly paroxetine, to aspirin therapy in patients with ischemic cardiovascular disease significantly increases the risk of gastrointestinal bleeding.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

BACKGROUND AND OBJECTIVE: Both aspirin and selective serotonin reuptake inhibitors (SSRIs) have been linked to an increased risk of gastrointestinal (GI) bleeding, while the interaction between the combined use of these two drugs on GI bleeding remains unclear. We aimed to explore the association between SSRIs use and risk of GI bleeding among aspirin users. METHODS: This is a prospective cohort study of 12,712 new aspirin users with a history of ischemic cardiovascular disease from the UK Biobank. Information on aspirin or SSRIs prescriptions was retrieved from primary care records, and GI bleeding data from hospital inpatient admissions. A competing risk model was used to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs). RESULTS: The incidence rate was 7.44 and 4.99 per 1000 person-years in the group of SSRIs and non-SSRIs use, respectively. A significant positive association was observed between SSRIs use and GI bleeding risk among aspirin users (Adjusted HR,1.27; 95 % CI, 1.01-1.58). The observed association was more pronounced in younger adults, females, individuals with a history of GI bleeding or those using PPIs. Besides, the association varied across different types of SSRIs, with paroxetine users showing the highest risk of GI bleeding (Adjusted HR, 1.73; 95 % CI, 1.06-2.83). CONCLUSION: This study indicated an additional risk of GI bleeding associated with SSRIs use in aspirin users, especially when combining paroxetine with aspirin. This finding underscores the necessity for further investigation into the differential risks of specific SSRIs to guide personalized polypharmacy.

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