Selective serotonin reuptake inhibitors and the risk of stroke: A population based case-control study

S. Bak, I. Tsiropoulos, J.O. Kjærsgaard, M. Andersen, E. Mellerup, J. Hallas, L.A. García Rodríguez, K. Christensen, D. Gaist

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs.

Methods— We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.

Results— Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates.

Conclusions— Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.
Original languageEnglish
JournalStroke
Volume33
Issue number6
Pages (from-to)1465-1473
ISSN0039-2499
DOIs
Publication statusPublished - 2002

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Serotonin Uptake Inhibitors
Case-Control Studies
Population
Odds Ratio
Platelet Aggregation
Confidence Intervals
Denmark
Prescriptions
Registries

Cite this

Bak, S. ; Tsiropoulos, I. ; Kjærsgaard, J.O. ; Andersen, M. ; Mellerup, E. ; Hallas, J. ; García Rodríguez, L.A. ; Christensen, K. ; Gaist, D. / Selective serotonin reuptake inhibitors and the risk of stroke : A population based case-control study. In: Stroke. 2002 ; Vol. 33, No. 6. pp. 1465-1473.
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title = "Selective serotonin reuptake inhibitors and the risk of stroke: A population based case-control study",
abstract = "Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs.Methods— We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.Results— Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95{\%} confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95{\%} CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates.Conclusions— Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.",
author = "S. Bak and I. Tsiropoulos and J.O. Kj{\ae}rsgaard and M. Andersen and E. Mellerup and J. Hallas and {Garc{\'i}a Rodr{\'i}guez}, L.A. and K. Christensen and D. Gaist",
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Selective serotonin reuptake inhibitors and the risk of stroke : A population based case-control study. / Bak, S.; Tsiropoulos, I.; Kjærsgaard, J.O.; Andersen, M.; Mellerup, E.; Hallas, J.; García Rodríguez, L.A.; Christensen, K.; Gaist, D.

In: Stroke, Vol. 33, No. 6, 2002, p. 1465-1473.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Selective serotonin reuptake inhibitors and the risk of stroke

T2 - A population based case-control study

AU - Bak, S.

AU - Tsiropoulos, I.

AU - Kjærsgaard, J.O.

AU - Andersen, M.

AU - Mellerup, E.

AU - Hallas, J.

AU - García Rodríguez, L.A.

AU - Christensen, K.

AU - Gaist, D.

N1 - 33: 1465-1473. (Ledsagende leder: Jakovljevic D, Tuomilehto J. Use of selective serotonin reuptake inhibitors and the risk of stroke: is there reason for concern

PY - 2002

Y1 - 2002

N2 - Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs.Methods— We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.Results— Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates.Conclusions— Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.

AB - Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs.Methods— We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors.Results— Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates.Conclusions— Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.

U2 - 10.1161/01.STR.0000018589.56991.BA

DO - 10.1161/01.STR.0000018589.56991.BA

M3 - Journal article

VL - 33

SP - 1465

EP - 1473

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -