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Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke
  1. Mark R Etherton1,2,
  2. Khawja A Siddiqui2,
  3. Lee H Schwamm1,2
  1. 1 Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Mark R Etherton; metherton{at}partners.org

Abstract

Background Selective serotonin reuptake inhibitors (SSRIs) have been implicated in contributing to recovery after acute ischaemic stroke. In particular, poststroke initiation of an SSRI has been demonstrated to improve motor recovery. The role of prestroke SSRI use on functional outcomes and stroke recovery is less clear. We aimed to examine the effect of prestroke SSRI use on metrics of hospitalisation and functional recovery.

Methods We included 4968 consecutive patients from January 2006 to June 2015 in our local Get With The Guidelines-Stroke registry in whom a preadmission drug list could be extracted from an administrative research data registry. Univariate and multivariate analyses were performed to identify predictors of functional outcomes.

Results On univariate analysis, among 4698 ischaemic strokes (740 SSRI users and 3948 non-users), SSRI use before acute ischaemic stroke did not impact the National Institutes of Health Stroke Scale (NIHSS) admission score, length of stay or rate of symptomatic haemorrhage. Patients using SSRIs prior to their stroke were more likely to present with weakness (57% vs 47.3%; P<0.001) and have hospitalisations complicated by pneumonia (7.6% vs 5.7%; P<0.001). Moreover, prestroke SSRI use was associated with a negative impact on ambulatory status at discharge and discharge to home. On multivariate regression analysis, SSRI use was associated with lower likelihood of discharge to home (adjusted OR 0.79, 95% CI 0.62 to 0.997, P<0.05).

Conclusions SSRI use preceding an acute ischaemic stroke is associated with lower rates of discharge to home despite no significant increase in length of stay or NIHSS score.

  • acute stroke
  • antidepressive agents
  • stroke rehabilitation

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Footnotes

  • Contributors MRE was responsible for study design, data acquisition and analysis, interpretation of data, drafting and revising the manuscript, final approval of the version to be published, and agreement to be accountable for all aspects of the work. KAS was responsible for data acquisition and analysis, critical revision of the manuscript for intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work. LHS was responsible for study design, interpretation of data, critical revision of the manuscript for intellectual content, final approval of the version to be published and agreement to be accountable for all aspects of the work.

  • Competing interests LHS: Chair of the AHA GWTG-Stroke Clinical Workgroup (unpaid), and stroke systems consultant to the Massachusetts Department of Public Health and received grant from its Center for Disease Control’s Paul Coverdell Acute Stroke Registry. He serves as a member of the independent international steering committee for the DIAS 3 and 4 trials of desmoteplase for AIS (Lundbeck); of the DSMB for the DeVOTE trial, a clinical trial comparing the cardiovascular safety of insulin degludec with that of insulin glargine in subjects with type 2 diabetes at high risk of cardiovascular events (Novo Nordisk); and the Clinical Event Committee and DSMB for the 3D Separator Trial of endovascular reperfusion in AIS (Penumbra). He is PI of the NINDS-funded MR Witness trial of extended window, MRE-guided alteplase (NCT01282242) for which Genentech provides alteplase free of charge to MGH for distribution, as well as modest per-patient supplemental site payments.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Massachusetts General Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors agree to make available the data used in this analysis for the purposes of reproducing the results and with permission by the local institutional review board.

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