SSRI/SNRI Use is Not Associated with Increased Risk of Delayed Cerebral Ischemia After aSAH
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ORIGINAL ARTICLE
SSRI/SNRI Use is Not Associated with Increased Risk of Delayed Cerebral Ischemia After aSAH Jimmy B. Young1 • Tarun D. Singh1 • Alejandro A. Rabinstein1 • Jennifer E. Fugate1
Ó Springer Science+Business Media New York 2015
Abstract Background To determine the effect of selective serotonin reuptake inhibitor (SSRI)/selective norepinephrine reuptake inhibitor (SNRI) use on the risk of symptomatic vasospasm and delayed cerebral ischemia (DCI) in patients hospitalized with aneurysmal subarachnoid hemorrhage (aSAH). Methods Retrospective review of consecutive patients with aSAH at Mayo Clinic, Rochester from January 2001 to December 2013. The variables collected and analyzed included age, sex, SSRI/SNRI use, active smoking, transfusion, modified Fisher score, WFNS grade, and outcome at discharge. Multivariate logistic regression analysis was used to evaluate factors associated with DCI, symptomatic vasospasm, and poor outcome (modified Rankin score 3–6) within 1 year. Results 579 [females 363 (62.7 %)] patients with a median age of 55 (IQR 47–65) years were admitted with aSAH during the study period. WFNS at nadir was IV–V in 240 (41.5 %), and modified Fisher score was 3–4 in 434 (75.0 %). 81 (13.9 %) patients had been prescribed an SSRI or SNRI prior to admission and all continued to receive these medications during hospitalization. & Jennifer E. Fugate [email protected] Jimmy B. Young [email protected] Tarun D. Singh [email protected] Alejandro A. Rabinstein [email protected] 1
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
Symptomatic vasospasm was present in 154 (26.4 %), radiological infarction in 172 (29.5 %), and DCI in 250 (42.9 %) patients. SSRI/SNRI use was not associated with the occurrence of DCI (p = 0.458), symptomatic vasospasm (p = 0.097), radiological infarction (p = 0.972), or poor functional outcome at 3 months (p = 0.376). Conclusions The use of SSRI/SNRI prior to and during hospitalization is not associated with DCI or functional outcome in patients with aSAH. Keywords Subarachnoid hemorrhage Delayed cerebral ischemia Vasospasm Critical-care Selective serotonin reuptake inhibitor
Introduction Clinicians taking care of patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently encounter complications such as delayed cerebral vasospasm, occurring in up to two-thirds of patients, and delayed cerebral ischemia (DCI) that develops in approximately half of those affected by vasospasm [1]. Without adequate treatment, DCI can often result in permanent disability or even mortality [2]. It has been long suspected that cerebral vascular tone may contribute in a large degree to irreversible complications that follow SAH [3]. Since vasospasm and DCI contribute to substantial morbidity in aSAH patients, avoiding medications that might cause or exacerbate vasoconstriction during this high-risk period appears logical. Medications with sympathomimetic and serotonergic properties precipitate potent cerebral vasoconst
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