Data on the risk gastrointestinal bleeding with use of selective serotonin reuptake inhibitors (SSRIs) have been equivocal. This Danish population-based case-control study was conducted to evaluate whether use of these agents is a cause of clinically important bleeding.

The study involved 3652 cases with a first discharge diagnosis of serious upper gastrointestinal bleeding (UGB) from 1995 to 2006 who were matched (age and sex) with 36,502 controls. Data on drug exposure and medical history were retrieved from a prescription database and the county's patient register, and the case-crossover design controlled for confounders.

The following adjusted odds ratio (OR) were reported (no absolute data available in abstract):

• UGB among current, recent, and past users of SSRIs: 1.67 (95% CI, 1.46 to 1.92), 1.88 (1.42 to 2.5), and 1.22 (1.07 to 1.39).

• Concurrent use of SSRI and NSAIDs: 8.0 (4.8 to 13).

• Concurrent use of NSAID, aspirin, and SSRI: 28 (7.6 to 103).

• UGB in the case crossover analysis: 2.8 (2.2 to 3.6)- of the UGB cases, 377 were current users of SSRI.

• Users of proton pump inhibitors: 0.96 (0.50 to 1.82).

The researchers conclude that “use of SSRI was associated with UGB, consistent with its antiplatelet effects. SSRIs should be prescribed with caution for patients at high risk for UGB.”