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The use of selective serotonin receptor inhibitors ( SSRI s) is not associated with increased risk of endoscopy‐refractory bleeding, rebleeding or mortality in peptic ulcer bleeding
Author(s) -
Laursen S. B.,
Leontiadis G. I.,
Stanley A. J.,
Hallas J.,
Schaffalitzky de Muckadell O. B.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14153
Subject(s) - medicine , discontinuation , odds ratio , refractory (planetary science) , gastroenterology , endoscopy , confounding , upper gastrointestinal bleeding , confidence interval , cohort study , peptic , prospective cohort study , surgery , peptic ulcer , physics , astrobiology
Summary Background Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors ( SSRI s), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRI s is often temporarily withheld in patients with peptic ulcer bleeding. However, abrupt discontinuation of SSRI s is associated with development of withdrawal symptoms in one‐third of patients. Further data are needed to clarify whether treatment with SSRI s is associated with poor outcomes, which would support temporary discontinuation of treatment. Aim To identify if treatment with SSRI s is associated with increased risk of: (1) endoscopy‐refractory bleeding, (2) rebleeding or (3) 30‐day mortality due to peptic ulcer bleeding. Methods A nationwide cohort study. Analyses were performed on prospectively collected data on consecutive patients admitted to hospital with peptic ulcer bleeding in Denmark in the period 2006‐2014. Logistic regression analyses were used to investigate the association between treatment with SSRI s and outcome following adjustment for pre‐defined confounders. Sensitivity and subgroup analyses were performed to evaluate the validity of the findings. Results A total of 14 343 patients were included. Following adjustment, treatment with SSRI s was not associated with increased risk of endoscopy‐refractory bleeding (odds ratio [ OR ] [95% Confidence Interval ( CI )]: 1.03 [0.79‐1.33]), rebleeding ( OR [95% CI ]: 0.96 [0.83‐1.11]) or 30‐day mortality ( OR [95% CI ]: 1.01 [0.85‐1.19]. These findings were supported by sensitivity and subgroup analyses. Conclusions According to our data, treatment with SSRI s does not influence the risk of endoscopy‐refractory bleeding, rebleeding or 30‐day mortality in peptic ulcer bleeding.