A literature review reveals very low certainty of evidence regarding the potential effect of SSRIs on platelet functions, with highly inconsistent findings across studies.
Do selective serotonin reuptake inhibitors affect platelet functions?
Current evidence on the intrinsic antiplatelet effects of SSRIs is highly inconsistent and of low certainty, necessitating further well-designed studies to account for confounding factors.
PURPOSE OF REVIEW: Many epidemiological studies have evidenced an increased bleeding risk associated with selective serotonin reuptake inhibitors (SSRIs), yet the underlying mechanisms remain unclear. This review summarizes data on SSRIs' effects on platelet functions assessed with assays used in clinical practice and highlights the areas that deserve further investigation. RECENT FINDINGS: Conflicting results of SSRI effects on platelet aggregation were observed irrespectively of the agonist used, the antidepressant drug or the study type. Alike, discrepant results were reported with flow-cytometry-based assays assessing either platelet surface glycoprotein levels, integrin activation, agonist-induced secretion of intraplatelet granule content or membrane anionic phospholipid exposure. Other tests may have detected a platelet function defect in SSRIs samples, however, results were largely inconsistent. SUMMARY: Critical literature examination unveils very low certainty of evidence on potential SSRI effect on platelet functions. Findings are often inconsistent even when similar methods are used, most likely because of differences in study design, included patients (age, comorbid conditions), SSRIs' type and dose, uncontrolled confounding factors, and statistical analysis power. Further studies are needed to disentangle any intrinsic antiplatelet effect of SSRIs and the multiple confounding factors, mainly the depression control itself and the degree of platelet SERT inhibition.
Mokhtarian et al. (Wed,) conducted a review in Patients taking selective serotonin reuptake inhibitors. Selective serotonin reuptake inhibitors (SSRIs) was evaluated on Platelet functions (aggregation, glycoprotein levels, integrin activation, secretion, phospholipid exposure). A literature review reveals very low certainty of evidence regarding the potential effect of SSRIs on platelet functions, with highly inconsistent findings across studies.