Serotonin Reuptake Inhibitor Drugs Are Associated with Contrast Extravasation and Clinical Outcome in Patients with Intracerebral Haemorrhage

Background: Antidepressants that inhibit the reuptake of serotonin (SRIs) have been related to the appearance of intracerebral haemorrhage (ICH). Some studies have described bigger haematoma volumes in these patients. So far, no studies have demonstrated an association between SRIs and contrast extravasation (CE). We propose to investigate the relationship of SRIs with CE and clinical outcome.

Patients and methods: We aimed a prospective registry of 294 patients with ICH. All previous treatments were registered, including SRIs intake. The presence of CE and the number of spot sign in CT angiography were collected. Early neurological deterioration (END) and late neurological deterioration (LND) were registered. Follow-up was completed at day 90.

Results: Two hundred and ninety-four patients were included, mean age 66.5 years, 27.6% female. A total of 28 (9.5%) were taking SRIs at the time of the ICH. This group of patients presented statistically significantly more CE (46.4 vs. 19.9%, p = 0.012), ≥2 spot sign (25 vs. 6.8%, p = 0.017), END (46.4 vs. 25.2%, p = 0.018) and LND (14.3 vs. 4.9%, p = 0.032). In addition, this group of patients showed a tendency to have higher mortality (32.1 vs. 22.2%, p = 0.553) and a lower functional independence (modified Rankin Scale 0-2) at day 90 (25 vs. 36.5%, p = 0.230). In the multivariate analysis, SRIs intake was identified as an independent predictor of CE (adjusted OR 3.37; 95% CI 1.033-10.989; p = 0.044) together with hematoma volume at baseline and alcohol use.

Conclusions: In our studied population, previous SRIs intake in patients with ICH was independently associated to CE. Further studies are needed to confirm this association.