(490) Serotonergic Antidepressants and Risk of Bleeding in Thrombocytopenia and Hematologic Malignancy

Introduction: Serotonin reuptake inhibitor (SRI) antidepressants are known to have antiplatelet properties. Patients with hematologic malignancies (HM) are at an increased risk of bleeding complications due to their malignancy and treatment-induced thrombocytopenia. Evidence describing the risk of bleeding with SRI use in this patient population is sparse. The purpose of this study was to evaluate the risk of clinically significant bleeding (CSB) in patients with HM and thrombocytopenia who are prescribed SRIs.

Methods: This retrospective cohort study included adult patients admitted to the hospital with HM and thrombocytopenia for five consecutive days. Patients were stratified into SRI exposed and unexposed groups. Patients were followed until resolution of thrombocytopenia, hospital discharge, death, or SRI therapy interruption. The primary outcome was the incidence of CSB, defined as bleeding that required medical intervention and/or treatment.

Results: Of the 324 patients evaluated, 119 were stratified to the SRI exposed group and 205 to the unexposed group. The median baseline platelet value was 35 K/μL and 31 K/μL, respectively. The median platelet nadir was 6 K/μL and median duration of study inclusion was 12 days in both groups. There were no significant differences in the incidence of CSB between the groups (15.9% vs 13.2%, p=0.487). No significant differences in hospital length of stay (LOS) (20 days vs 19 days, p=0.227) or ICU LOS (3.9 days vs 3.9 days, p=0.996) were identified. Severe thrombocytopenia greater than 4 days and corticosteroid exposure were more common in patients who experienced a CSB compared to those who did not. Duration of severe thrombocytopenia, and corticosteroid exposure were independently associated with an increase in the odds of CSB, whereas SRI exposure was not.

Conclusions: In patients with HM and thrombocytopenia, the use of an SRI was not associated with an increased risk of CSB and can likely continue to be used safely in this patient population.