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SEROTONIN SELECTIVE REUPTAKE INHIBITORS (SSRIs) ARE NOT ASSOCIATED WITH AN INCREASED RISK OF UPPER GASTROINTESTINAL EVENTS IN USERS OF NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDs)
LE Targownik, CJ Metge, S Leung
INTRODUCTION: Retrospective reviews have suggested that SSRIs may increase the risk of gastrointestinal hemorrhage in NSAID users by up to 13.6 times. However, these results have yet to be confirmed prospectively and the physiologic basis linking SSRI use to an increased risk of gastrointestinal bleeding is not definite.
METHODS: We used the Manitoba Health Research Data Repository to identify all subjects admitted to hospital with a diagnosis consistent with an upper gastrointestinal complication who had been actively using NSAIDs. Cases were matched to NSAID using controls on age, sex, and index date. Subjects were considered to be using SSRIs if they were actively using SSRIs in the fourteen days prior to the date of the cases admission. Conditional logistic regression was used to obtain crude and adjusted odds ratios, controlling for medical comorbidities, use of other medications which affect the risk of gastrointestinal bleeding, and the type and duration of NSAID use.
Results: We identified 1,382 cases admitted with upper gastrointestinal complications, who were matched to 33,957 controls. SSRI were being actively used by 8.3% of cases and 6.7% of controls, for a crude odds ratio of 1.32 (95% CI 1.08-1.61, p=0.0079). However, after adjustment for multiple potential confounding variables, the association between SSRI use and upper gastrointestinal complications among NSAID users was not statistically significant (OR 1.14, 95% CI 0.92-1.41).
CONCLUSION: SSRI use does not appear to be associated with a significant risk of upper gastrointestinal bleeding among users of NSAIDs. Further study is required to determine whether SSRIs can be used without concern for gastrointestinal complications in chronic NSAID users.