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Neurology
www.neurology.org Published online before print October 17, 2012, doi: 10.1212/WNL.0b013e318271f848 Neurology WNL.0b013e318271f848 Article

Selective serotonin reuptake inhibitors and brain hemorrhage

A meta-analysis
Daniel G. Hackam, MD, PhD, FRCPC and Marko Mrkobrada, MD, FRCPC
+ SHOW AFFILIATIONS | + SHOW FULL DISCLOSURES Correspondence & reprint requests to Dr. Hackam: dhackam@uw o.ca

Published online before print October 17, 2012, doi: 10.1212/WNL.0b013e318271f848 Neurology WNL.0b013e318271f848

Abstract
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Data Supplement Accompanying Editorial Abstract in Arabic

ABSTRACT
Objective: We synthesized the epidemiologic evidence concerning selective serotonin reuptake inhibitor (SSRI) exposure and the risk of CNS hemorrhage. Methods: We searched for controlled observational studies comparing SSRI therapy with a control group not receiving SSRIs. We used DerSimonian and Laird fixed effect models to compute summary risk associations. Results: Intracranial hemorrhage was related to SSRI exposure in both unadjusted (rate ratio [RR] 1.48, 95% confidence interval [CI] 1.221.78) and adjusted analyses (RR 1.51, 95% CI 1.261.81). Intracerebral hemorrhage was also associated with SSRI exposure in both unadjusted (RR 1.68, 95% CI 1.461.91) and adjusted (RR 1.42, 95% CI 1.231.65) analyses. In a subset of 5 studies (3 of intracranial hemorrhage and 1 each reporting hemorrhagic stroke and intracerebral hemorrhage), SSRI exposure in combination with oral anticoagulants was associated with an increased risk of bleeding compared with oral anticoagulants alone (RR 1.56, 95% CI 1.331.83). When all studies were analyzed together, increased risk was seen across cohort studies (1.61, 95% CI 1.042.51), case-control studies (odds ratio [OR] 1.34, 95% CI 1.201.49), and case-crossover studies (OR 4.24, 95% CI 1.959.24). Conclusions: SSRI exposure is associated with an increased risk of intracerebral and intracranial hemorrhage, yet given the rarity of this event, absolute risks are likely to be very low. Received March 5, 2012. Accepted June 7, 2012. Copyright 2012 by AAN Enterprises, Inc.

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Print ISSN: 0028-3878 Online ISSN: 1526-632X

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