Table 4.
Relative Risk (95% CI) of ischemic stroke by SSRI use and hemorrhagic stroke by SSRI among older Medicare beneficiaries with TBI
| Ischemic Stroke | ||
| SSRI Usea | Unadjusted | Adjustedb |
| No Use | Reference | Reference |
| Citalopram (n=4,047) | 1.21 (1.02, 1.43) | 0.95 (0.79, 1.13) |
| Escitalopram (n=3,612) | 1.38 (1.17, 1.64) | 1.07 (0.91, 1.28) |
| Fluvoxamine (n=18) | N/Ac | N/Ac |
| Fluoxetine (n=918) | 1.51 (1.08, 2.11) | 1.27 (0.91, 1.77) |
| Paroxetine (n=1,077) | 1.01 (0.70, 1.45) | 0.87 (0.61, 1.26) |
| Sertraline (n=3,239) | 1.25 (1.04, 1.51) | 1.02 (0.84, 1.23) |
| Hemorrhagic Stroke | ||
| SSRI Usea | Unadjusted | Adjustedb |
| No Use | Reference | Reference |
| Citalopram (n=4,047) | 1.33 (1.02, 1.75) | 1.23 (0.93, 1.63) |
| Escitalopram (n=3,612) | 1.47 (1.13, 1.92) | 1.33 (1.02, 1.74) |
| Fluvoxamine (n=18) | N/Ac | N/Ac |
| Fluoxetine (n=918) | 1.42 (0.81, 2.51) | 1.40 (0.79, 2.48) |
| Paroxetine (n=1,077) | 1.45 (0.87, 2.41) | 1.47 (0.88, 2.44) |
| Sertraline (n=3,239) | 1.54 (1.17, 2.03) | 1.46 (1.10, 1.94) |
Numbers associated with specific drugs reflect that total number of beneficiaries that had a fill for the specific drug at any time following TBI.
All models adjusted for: age, race, sex, warfarin use in period, length of hospital stay, discharge to a skilled nursing facility, history of depression, incident depression, atrial fibrillation, Alzheimer’s disease and related dementias, hypertension. Ischemic stroke model also included hyperlipidemia, ischemic heart disease, congestive heart failure, prior ischemic stroke, and diabetes. Hemorrhagic stroke model also included liver disease, chronic kidney disease, alcohol abuse, anemia, coagulation defect, valvular heart disease, neurological disease, prior hem stroke
N/A—estimate is too small and unreliable.
Abbreviations: TBI, traumatic brain injury; CI, confidence interval; SSRI, selective serotonin reuptake inhibitor