Adam Urato: The Platelet Paradox of SSRIs

Adam Urato/X, Sanil Rege/LinkedIn Adam Urato, Maternal-Fetal Medicine Physician at MetroWest Medical Center, shared a post on X about a recent article by Amir Mahdi Ghafarian et al., published in AJS, adding: 'New study: Patients on SSRI/SNRIs undergoing colon surgery had increased bleeding and blood transfusion rates. These drugs have chemical effects on platelets – lowering platelet serotonin. Increased rates of postpartum hemorrhage, GI bleeding, & other postsurgical bleeding have previously been demonstrated. The authors write: 'By inhibiting platelet serotonin reuptake, these agents deplete the platelet serotonin that supports aggregation and hemostasis, providing a biological basis for increased bleeding.'' Sanil Rege, Consultant Psychiatrist and Director of Mental Health at Beleura Private Hospital, shared this post on X, adding: 'But what's the other side of the equation. The same effect on platelets is protective in other scenarios. SSRIs and myocardial infarction (MI) risk Long-term SSRI use reduces MI risk. 'The use of SSRIs may confer a protective effect against MI. This could be attributable to the inhibitory effect SSRIs have on serotonin-mediated platelet activation or possibly amelioration of other factors associated with increased risk for MI in depression.' Why? Serotonin promotes platelet aggregation and vasoconstriction of diseased coronary arteries. Less platelet serotonin is equal to lower clot formation risk which is equal to lower coronary artery occlusion risk. Prescribing a medication is a risk benefit analysis. If you look at only one side of the equation without understanding the person for whom you are prescribing for, you aren't really performing a risk benefit analysis. Thus – Bleeding risk increases due to impaired platelet aggregation – MI risk decreases due to reduced clot formation Hence nuance is needed in cardiovascular medicine where other anticoagulants and NSAIDs may be prescribed.' Title: Perioperative selective serotonin reuptake inhibitor and serotonin–norepinephrine reuptake inhibitor use and 30-day bleeding after elective colectomy Authors: Amir Mahdi Ghafariana, Nikeeta Nancooc, Hanieh Ghafariana, Darby Larsonc, Cicely Marie Montesinosc, Abubaker A. Alid, Abraham El-Sedfye, Awni Shahait Stay updated with Hemostasis Today.