# Exacerbation of Intracranial and Gastrointestinal Bleeding in Patients Above 50 Years of Age Co-treated With Antidepressants and Anticoagulants/Platelet Inhibitors at a Lebanese University Hospital

## TL;DR

This study examines if combining antidepressants with blood-thinning drugs increases bleeding risks in elderly patients but finds no significant link.

## Contribution

The study provides new evidence on drug interactions in elderly patients, challenging assumptions about antidepressant and anticoagulant combinations.

## Key findings

- No correlation found between antidepressant and anticoagulant/antiplatelet co-administration and increased bleeding.
- Bleeding severity was significantly associated with prothrombin time and INR, not antidepressant use.
- Clinical diagnosis and heart failure were key factors in bleeding severity.

## Abstract

Background and objective: Depression is prevalent in the elderly, to whom the administration of anticoagulants (AC) and antiplatelets (antiaggregants (AG)) is frequent. Antidepressants (AD) work on increasing serotonin levels in the central nervous system (CNS) and are thought to decrease serotonin levels in platelets, an important factor in homeostasis. The effect of the co-administration of AD and AC/AG on increased bleeding risk is controversial; hence, our objective is to determine the effect of AD and AC/AG co-administration on the exacerbation and severity of bleeding in the elderly.

Subjects and methods: A monocentric retrospective study was conducted at the Lebanese Hospital Geitaoui by reviewing charts of 135 patients with gastrointestinal bleeding (GIB) and intracranial bleeding (ICB) hospitalized between 2015 and 2020. Proportions of patients treated with AD and AG, AD and AC, AD alone, or untreated with AD were determined. The studied parameters were demographic variants, medical and surgical histories, medication profiles, hemostasis tests, computed tomography (CT) scans, magnetic resonance imaging (MRI), endoscopies, and characteristics of the bleeding classified according to the Bleeding Severity Measurement Score (BSMS).

Results: No positive correlation was found between AD and AC/AG co-administration and bleeding. Factors such as gender, age, body mass index (BMI), alcoholism, smoking, hypertension, diabetes, history of malignancy, dyslipidemia, chronic kidney disease (CKD), and coronary artery disease (CAD) were not statistically associated with intracranial hemorrhage (ICH) or GIB. Prothrombin time (PT) and international normalized ratio (INR) were significantly (p < 0.05) associated with bleeding severity. Multivariate analysis showed that bleeding severity increases with the clinical diagnosis (p < 0.001) and in patients with heart failure (p = 0.023).

Conclusion: Our study could not prove the potential drug-drug interaction (DDI) between AC/AG and AD. With the increased prevalence of mental disorders and prescribed antidepressants, proving the potential drug-drug interaction is of major importance. More research with diverse approaches on a larger scale is required in this regard.