Clinical neurology and neurosurgery · 2024
Association of SSRI and SNRI use with incident hyponatremia after subarachnoid hemorrhage.
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Piedmont Jacqueline, Chung David, Webb Andrew
Аннотация
BACKGROUND: Hyponatremia is common following subarachnoid hemorrhage (SAH) and is associated with vasospasm and delayed cerebral ischemia (DCI). Risk factors for post-SAH hyponatremia are poorly defined; however, selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are associated with hyponatremia in non-SAH populations. This study assessed whether pre-admission SSRIs/SNRIs were associated with hyponatremia after SAH.
METHODS: This was a single-center retrospective study at a comprehensive stroke center. Patients were included if they were admitted for nontraumatic SAH (aneurysmal, perimesencephalic, or angiography-negative) and were excluded if they died within 24 h of presentation or were hyponatremic on admission. The primary endpoint was the incidence of hyponatremia. Key secondary endpoints included incidence of vasospasm, DCI, and rebleeding and discharge modified Rankin scale.
RESULTS: 292 patients were included; 49 patients were prescribed an SSRI or SNRI prior to admission. Of those included, 55.5 % had a Hunt and Hess score of 1 or 2, and 45 % of patients had anterior aneurysms. 11 % and 26 % of patients had perimesencephalic and CTA-negative SAH respectively. Hyponatremia occurred in 37 % of patients prescribed SSRIs/SNRIs vs 30 % of patients not on SSRIs/SNRIs (p = 0.36). Incidence of radiographic vasospasm in the SSRI/SNRI group was 33 % compared to 21 % in the non-SSRI/SNRI group (p = 0.065).
CONCLUSIONS: We did not find an association that reached our predefined statistical threshold between pre-admission SSRI/SNRI utilization and hyponatremia or secondary endpoints including vasospasm. This study suggests serotonergic therapies do not cause large effects on hyponatremia or clinically relevant complications after SAH.
METHODS: This was a single-center retrospective study at a comprehensive stroke center. Patients were included if they were admitted for nontraumatic SAH (aneurysmal, perimesencephalic, or angiography-negative) and were excluded if they died within 24 h of presentation or were hyponatremic on admission. The primary endpoint was the incidence of hyponatremia. Key secondary endpoints included incidence of vasospasm, DCI, and rebleeding and discharge modified Rankin scale.
RESULTS: 292 patients were included; 49 patients were prescribed an SSRI or SNRI prior to admission. Of those included, 55.5 % had a Hunt and Hess score of 1 or 2, and 45 % of patients had anterior aneurysms. 11 % and 26 % of patients had perimesencephalic and CTA-negative SAH respectively. Hyponatremia occurred in 37 % of patients prescribed SSRIs/SNRIs vs 30 % of patients not on SSRIs/SNRIs (p = 0.36). Incidence of radiographic vasospasm in the SSRI/SNRI group was 33 % compared to 21 % in the non-SSRI/SNRI group (p = 0.065).
CONCLUSIONS: We did not find an association that reached our predefined statistical threshold between pre-admission SSRI/SNRI utilization and hyponatremia or secondary endpoints including vasospasm. This study suggests serotonergic therapies do not cause large effects on hyponatremia or clinically relevant complications after SAH.