Coronary disease & ACSCohort study
Selective serotonin reuptake inhibitors and bleeding risk in patients undergoing percutaneous coronary intervention (PCI) on dual antiplatelet therapy: a retrospective cohort study
- retrospective cohort study
- Propensity-score matching (1:1)
- TriNetX Global Collaborative Network
Authors' conclusion
In this large, retrospective, real-world cohort, concomitant SSRI therapy during DAPT was associated with an increased bleeding risk, primarily driven by intracranial and gastrointestinal events, without a corresponding increase in ischaemic outcomes, highlighting the importance of clinical awareness of this pharmacodynamic interaction, particularly in higher-risk subgroups, and underscoring the value of established bleeding prevention strategies in this population.
Study context
- Population
- Adults (≥18 years) who underwent PCI with 12 months of dual antiplatelet therapy (DAPT) (aspirin plus a P2Y12 inhibitor) between January 2013 and August 2024PCI patients on DAPT, 3847 used selective serotonin reuptake inhibitors (SSRIs), after matching 3023 vs 3023
- Participants
- 29,973 adults
- Exposure
- SSRI users vs non-users
- SSRI usersn = 3,023
- non-usersn = 3,023reference
- Outcome
- Any major bleeding (ICH, GIB, requirement for blood transfusion, or other major bleeding)
- Follow-up
- 1 year
Main finding
As reported in the abstract
Hazard ratio
1.28
95% CI 1.11–1.48
P < 0.001
By group
SSRI users vs non-users
HR 1.28 (95% CI 1.11–1.48); P < 0.001
Observational data: associations, not effects.
Secondary outcomes
| Outcome | SSRI users | non-users | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| ICH | 1.2% | 0.7% | 1.73 (1.01–2.97) | P = 0.043 | |
| GIB | 7.4% | 5.6% | 1.34 (1.10–1.63) | P = 0.004 | |
| Red blood cell transfusion | 4.6% | 4.1% | 1.15 (0.90–1.46) | P = 0.267 | |
| All-cause mortality | 4.1% | 3.8% | 1.08 (0.83–1.39) | P = 0.573 | |
| 0.20.5125Hazard ratio (log scale) |
Ischaemic outcomes
- comparable between groups
Subgroups
- Association strongest in patients aged ≥65 years, with hypertension, chronic kidney disease, or concomitant NSAID use; consistent across ACS and non-ACS presentations
Original publication
Selective serotonin reuptake inhibitors and bleeding risk in patients undergoing PCI on dual antiplatelet therapy: a retrospective cohort study. Eur Heart J Cardiovasc Pharmacother. Published 15 May 2026. doi:10.1093/ehjcvp/pvag034
Summarised from the published abstract; every number is checked against it