Antidepressants with high serotonin reuptake inhibition (fluoxetine, paroxetine, sertraline) are associated with abnormal bleeding, decreased platelet aggregability, and prolonged bleeding time.
Do antidepressants, particularly SSRIs, cause abnormal bleeding and modify hemostasis markers?
SSRIs are associated with abnormal bleeding and platelet dysfunction, highlighting the need for careful monitoring and alternative antidepressant choices in patients with underlying coagulation disorders.
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are widely used for the treatment of depression and anxious disorders. The observation that depression is an independent risk factor for cardiovascular mortality and morbidity in patients with ischemic heart disease, the assessment of the central role of serotonin in pathophysiological mechanisms of depression, and reports of cases of abnormal bleeding associated with antidepressant therapy have led to investigations of the influence of antidepressants on hemostasis markers. In this review, we summarize data regarding modifications of these markers, drawn from clinical studies and case reports. We observed an association between the type of antidepressant drug and the number of abnormal bleeding case reports, with or without modifications of hemostasis markers. Drugs with the highest degree of serotonin reuptake inhibition--fluoxetine, paroxetine, and sertraline--are more frequently associated with abnormal bleeding and modifications of hemostasis markers. The most frequent hemostatic abnormalities are decreased platelet aggregability and activity, and prolongation of bleeding time. Patients with a history of coagulation disorders, especially suspected or documented thrombocytopenia or platelet disorder, should be monitored in case of prescription of any serotonin reuptake inhibitor (SRI). Platelet dysfunction, coagulation disorder, and von Willebrand disease should be sought in any case of abnormal bleeding occurring during treatment with an SRI. Also, a non-SSRI antidepressant should be favored over an SSRI or an SRI in such a context. Considering the difficulty in performing platelet aggregation tests, which are the most sensitive in SRI-associated bleeding, and the low sensitivity of hemostasis tests when performed in case of uncomplicated bleeding in the general population, establishing guidelines for the assessment of SRI-associated bleeding complications remains a challenge.
Halperin et al. (Sat,) conducted a review in Depression and anxious disorders. Antidepressants (particularly SSRIs) was evaluated on Abnormal bleeding and modifications of hemostasis markers. Antidepressants with high serotonin reuptake inhibition (fluoxetine, paroxetine, sertraline) are associated with abnormal bleeding, decreased platelet aggregability, and prolonged bleeding time.
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