Risk of Intracranial Hemorrhage and Utilization of Selective Serotonin Reuptake inhibitors: A Systematic Review and Meta-analysis

Background: Selective serotonin reuptake inhibitors (SSRIs) have the potential to reason an obtained hemostatic defect related to their capacity to inhibit platelet characteristics. Especially, SSRIs inhibit the serotonin transporter on platelets, causing a lower in intra platelet serotonin and diminished remarks activation at some point of dense granule secretion, leading to intracranial hemorrhage (ICH). Aim: This work aims to determine the safety of utilization of Selective Serotonin Re-uptake Inhibitors (SSRI), regarding the incidence of Intra-cranial hemorrhage (ICH). Materials and Methods: A systematic search was performed over different medical databases to identify Neurology studies, which studied the outcome of the SSRI users group versus the Non-SSRI users' group of patients. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on the incidence of intracranial hemorrhage as the main primary outcome. Results: Seven studies were identified involving 153323 patients, with 19010 patients in the SSRI users group, and 134313 patients in the Non-SSRI users' group. The meta-analysis process revealed a significant increase in the incidence of intracranial hemorrhage in the SSRI users group compared to the Non-SSRI users' group (p=0.033). Conclusion: To conclude, SSRIs exposure after ICH is associated with both improvement in depressive symptoms and increased risk of recurrent hemorrhagic stroke. Clinical history, neuroimaging data, and genetic biomarkers may help to identify survivors of ICH more likely to safely tolerate SSRI use.