Selective Serotonin Reuptake Inhibitors Increase Gastrointestinal but Not Other Site Bleeding Risk in Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES

To evaluate the association between selective serotonin reuptake inhibitor (SSRI) use and bleeding complications in patients with left ventricular assist devices (LVADs), with particular focus on gastrointestinal (GI) bleeding, overall bleeding risk, and international normalized ratio (INR) levels at the time of bleeding.

DESIGN

Systematic review and meta-analysis of observational studies.

SETTING

Multicenter studies conducted in tertiary care academic hospitals across the United States and Europe.

PARTICIPANTS

A total of 1,108 adult patients with implanted LVADs, of whom 431 were on SSRI therapy and 677 served as controls without SSRI exposure.

INTERVENTIONS: Exposure to SSRIs prior to or during LVAD support, compared with no SSRI therapy.

RESULTS

The primary outcome was GI bleeding. Secondary outcomes included bleeding from any anatomical site and INR values at the time of GI bleeding. SSRI use was significantly associated with increased risk of GI bleeding (risk ratio 1.61, 95% confidence interval [CI]: 1.19-2.17; p = 0.0019), but the overall risk of bleeding from any anatomical site, including GI and non-GI sources, did not reach statistical significance (risk ratio 1.44, 95% CI: 0.86-2.39; p = 0.16) or INR values (mean difference 0.22, 95% CI: -0.71 to 1.16; p = 0.64). Sensitivity analyses and publication bias assessments supported the robustness of these findings.

CONCLUSIONS

In patients with LVADs, SSRI use is associated with a significantly increased risk of GI bleeding. These findings highlight the need for individualized bleeding risk assessment and GI prophylaxis in LVAD patients requiring antidepressant therapy.