Background and Purpose- Selective serotonin reuptake inhibitors (SSRIs) have a well-established association with bleeding complications and conflicting reports on outcome after stroke. We sought to evaluate whether pre-intracerebral hemorrhage (ICH) SSRI use increased ICH risk and post-ICH SSRI use improved ICH outcome. Methods- Through post hoc analysis of the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage), SSRI use was categorized into no use, pre-ICH only, pre- and post-ICH use (termed "continuous"), and post-ICH only (termed "new"). Using multivariable modeling, associations were sought between pre-ICH SSRI use and ICH risk in the case-control set, and associations between post-ICH SSRI use and 3-month outcome were analyzed in the ICH case set. Exploratory analyses sought to assess influence of race/ethnicity in models. Results- The final study cohort consisted of 2287 ICH cases and 2895 controls. Pre-ICH SSRI use was not associated with ICH risk (odds ratio, 0.824 [95% CI, 0.632-1.074]) nor potentiation of ICH risk with anticoagulant or antiplatelet use. New post-ICH SSRI use was associated with unfavorable modified Rankin Scale score at 3 months after ICH (odds ratio,1.673 [95% CI,1.162-2.408]; P=0.006) in multivariable analyses. Additional propensity score analysis indicated a similar trend but did not reach statistical significance (P=0.107). When stratified by race/ethnicity, multivariable modeling demonstrated reduced ICH risk with pre-ICH SSRI use in Hispanics (odds ratio, 0.513 [95% CI,0.301-0.875]; P=0.014), but not non-Hispanic whites or blacks, and no associations between post-ICH SSRI use and 3-month outcome in any racial/ethnic group. Conclusions- In a large multiethnic cohort, pre-ICH SSRI use was not associated with increased ICH risk, but post-ICH SSRI use was associated with unfavorable 3-month neurological outcome after ICH. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01202864.

中文翻译：

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选择性5-羟色胺再摄取抑制剂与脑出血风险和结果。

背景和目的：选择性5-羟色胺再摄取抑制剂（SSRI）与出血并发症和中风后预后的报道相互矛盾。我们试图评估前脑出血（ICH）SSRI使用是否增加ICH风险和后ICH SSRI使用改善ICH结果。方法-通过对ERICH研究的事后分析（脑出血的种族/种族差异），SSRI的使用被分类为不使用，仅在ICH之前，在ICH之前和之后使用（称为“连续”）以及仅ICH（称为“新”）。使用多变量建模，在病例对照组中寻找ICH前SSRI使用与ICH风险之间的关联，并在ICH病例组中分析ICH SSRI使用后与3个月结果之间的关联。探索性分析旨在评估模型中种族/民族的影响。结果-最终研究队列包括2287例ICH病例和2895例对照。ICH前SSRI的使用与ICH风险无关（比值比为0.824 [95％CI，0.632-1.074]），也不与抗凝药或抗血小板药物的使用增加ICH风险。在多变量分析中，新的ICH后SSRI使用与ICH后3个月时不利的改良Rankin量表评分相关（比值1.673 [95％CI，1.162-2.408]； P = 0.006）。其他倾向得分分析表明趋势相似，但未达到统计学显着性（P = 0.107）。当按种族/种族进行分层时，多变量模型显示在西班牙裔患者中使用ICH前SSRI可以降低ICH风险（优势比为0.513 [95％CI，0.301-0.875]； P = 0.014），而非西班牙裔白人或黑人除外。而且，在任何种族/族裔群体中，ICH-SSRI使用后与3个月预后之间没有关联。结论-在一个大型的多族群中，ICH前SSRI的使用与ICH风险增加无关，但是ICH后SSRI的使用与ICH后3个月的神经功能不良有关。注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01202864。