Loading…
← Back to schedule
Effects of selective serotonin reuptake inhibitors on stress ulcer bleeding in critically ill patients
Friday April 25, 2025 8:50am - 9:05am EDT
Athena G
Title: 
Effects of selective serotonin reuptake inhibitors on stress ulcer bleeding in critically ill patients


Authors: 
Morgan Keller, Sabrina Croft, Joseph Crosby


Objective: 
To be presented in slides


Self Assessement Question: 
To be presented in slides


Background:
Critically ill patients in the intensive care unit have increased risk for gastrointestinal complications, including stress ulcers and bleeding due to physiological stress, mechanical ventilation, and pharmacological interventions such as anticoagulants and corticosteroids. Prophylactic treatments such as proton pump inhibitors and H2-receptor antagonists are commonly used to mitigate this risk. The aim of this study is to determine whether the use of selective serotonin reuptake inhibitors is associated with an increased incidence of gastrointestinal bleeding with critically ill patients.


Methods:
This retrospective, observational chart review evaluates adult patients who are critically ill and admitted to one of the St. Joseph’s/Candler intensive care units who are taking selective serotonin reuptake inhibitor medications compared to patients with a comparator ICD 10 code (NSTEMI I21.4) not taking selective serotonin reuptake inhibitor therapy. A computer-generated list identified patients who were admitted to one of the St. Joseph’s/Candler intensive care unit (ICU), coronary care unit (CCU), or neuro-intensive care unit (NICU) with selective serotonin reuptake inhibitor therapy in patient from August 1 2020-August 1 2024. Comparatively, a second computer-generated list identified patients who were admitted to one of the St. Joseph’s/Candler ICU, CCU, or NICU with ICD 10 code I21.4 from August 1 2020-August 1 2024. Subjects were then be reviewed for study inclusion or exclusion based on the aforementioned criteria, and Microsoft office excel was used to randomize patients and select 50 patients per treatment arm. Chart review was conducted to determine if the patient was diagnosed with a gastrointestinal bleed during their specific visit. All data was collected and analyzed through Microsoft office excel. Primary outcomes and input variables are summarized with means and standard deviations for continuous measures, and proportions and percentages for non-continuous measures. Any adjusted analysis conducted was through multivariable regression.


Results:
Among the 100 critically ill patients admitted to the ICU, CCU, or NICU unit at St. Joseph’s and Candler Hospital, nine (9%) of patients were found to have a gastrointestinal bleed. Of the 9 patients who had a gastrointestinal bleed, seven (77.8%) of the patients were not on selective serotonin reuptake inhibitor therapy (SSRI) whereas 2 (22.2%) were on SSRI therapy. Among the nine patients diagnosed with a gastrointestinal bleed, five patients were in the CCU, one patient in the NICU, one patient in the St. Joseph’s ICU, and two patients in the Candler ICU. 71 (71%) of patients were on stress ulcer prophylaxis with either proton pump inhibitors or histamine type-2 receptor antagonists and only one of these patients experienced a gastrointestinal bleed. 
The primary endpoint analysis demonstrated no statistically significant association between SSRI therapy and increased risk of gastrointestinal bleeding in critically ill patients admitted into intensive care units, (p-value of 0.08). The lack of statistical significance suggests other clinical factors may contribute to the numerically fewer patients who experienced gastrointestinal bleeding on selective serotonin reuptake inhibitor medications than those patients not on selective serotonin reuptake inhibitor therapy.


Conclusion:
Selective serotonin reuptake inhibitor therapy does not appear to significantly increase the risk of gastrointestinal bleeding in critically ill patients admitted to intensive care units. Despite the predisposing factors of these patients to gastrointestinal complications, the observed incidence of bleeding was not higher in patients receiving selective serotonin reuptake inhibitors compared to those not receiving selective serotonin reuptake inhibitors who were diagnosed with NSTEMI. Considering the study’s limitations of retrospective design and small sample size, further research with larger, multicenter data should explore the potential relationship of selective serotonin reuptake inhibitors and gastrointestinal bleeding risk in critically ill patients. 
Moderators
avatar for Tia Collier

Tia Collier

Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
Presenters
MK

Morgan Keller

Pharmacy Resident, St. Joseph's/Candler Health System
avatar for Morgan Keller

Morgan Keller

PGY1 Resident, Candler Hospital
Dr. Morgan Keller is originally from Longwood, Florida. She completed her Bachelor’s Degree in Interdisciplinary Medical Sciences at Florida State University before completing her Doctor of Pharmacy Degree from Auburn University’s Harrison College of Pharmacy. Dr. Keller is completing... Read More →
Evaluators
avatar for Sarah Frye

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →
Friday April 25, 2025 8:50am - 9:05am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Candler Hospital
  • global Y
Feedback form is now closed.

Attendees (30)


Sign up or log in to save this to your schedule, view media, check-in, leave feedback and see who's attending!

Tweet Share
Share Modal

Share this link via

Or copy link