快樂小藥師 Im pharmacist nichts glücklich

Further evidence indicates yes.

Previous studies suggest that the use of selective serotonin reuptake inhibitors (SSRIs) increases the risk for upper gastrointestinal bleeding (UGIB). To investigate this issue further, investigators conducted a meta-analysis of 22 observational studies (6 cohort and 16 case-control studies) that included 1,073,000 patients and compared the frequency of UGIB events in SSRI users versus nonusers.

SSRI users had a 50% increased risk for UGIB compared with nonusers (pooled odds ratio, 1.55; 95% confidence interval, 1.35–1.78). Both antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) increased the risk for a bleeding episode; the concomitant use of both with SSRIs resulted in a ninefold elevated risk for UGIB (pooled OR, 9.13; 95% CI, 1.12–74.77). The use of acid-suppressive medication eliminated the risk difference between groups.

COMMENT

The reliability of the estimated effects in this analysis may be limited; persistent evidence of heterogeneity of the selected studies suggests the presence of potential confounders. Subgroup analyses did not identify the source of heterogeneity, but possible sources include differences in definitions of UGIB, variable inclusion of variceal bleeding, and variations in medications and populations studied. The summary risk estimate reported in this paper is similar to that of another recent meta-analysis (Am J Gastroenterol 2014; 109:811 [PubMed® abstract]), which also showed elevated risk with SSRIs in the setting of NSAID use and significant heterogeneity in the data. Even with the potential limitations of the heterogeneous studies in these meta-analyses, the results are consistent with growing evidence that SSRIs can increase the risk for UGIB.

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Jiang H-Y et al. Clin Gastroenterol Hepatol 2014 Jun 30.

CITATION(S):

Jiang H-Y et al. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2014 Jun 30; [e-pub ahead of print].
[PubMed® abstract]