Controversial and unresolved aspects of drug-induced hemorrhagic stroke: focus on selective serotonin reuptake inhibitors, non-steroidal anti-inflammatory drugs and statins


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Abstract

Hemorrhagic stroke (HS) is a polyetiological disease that includes all forms of non-traumatic intracranial hemorrhage. HS is an important disease for clinical practice, because it is characterized by a high morbidity and mortality. Drugs are considered one of the important etiological factors of this disease. In addition to drugs that affect hemostasis, the literature also describes an increase in the risk of HS against the background of the use of antidepressants of the group of selective serotonin reuptake inhibitors (SSRIs), non-steroidal anti-inflammatory drugs (NSAIDs) and statins. Large systematic reviews revealed an increase in the risk of all subtypes of HS against the background of the use of SSRIs; the increased risk may correlate with the strength of serotonin uptake inhibition. In this case, a possible measure for the prevention of HS may be the use of SSRIs with weak inhibition strength. The issue of NSAID-induced HS is complex and not fully understood. This side effect has not been identified in randomized controlled trials, and the results of meta-analyses and systematic reviews are conflicting. Nevertheless, physicians should take into account the potential risk of developing HS with the use of NSAIDs. Statins, for which some data on the risk of intracerebral hemorrhage (ICH) have been published, cannot be considered a HS inducers after numerous meta-analyses. Moreover, there is evidence of a reduction in the risk of ICH with statin therapy.

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About the authors

A. I Listratov

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

T. M Ostroumova

Sechenov First Moscow State Medical University (Sechenov University)

Moscow, Russia

A. I Kochetkov

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

Olga D. Ostroumova

Russian Medical Academy of Continuous Professional Education; Sechenov First Moscow State Medical University (Sechenov University)

Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology n.a. Academician M.S. Vovsi; Professor at the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases Moscow, Russia

D. A Sychev

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

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